VARIOUS PATTERNS OF PULMONARY VEINS OPEN ING IN THE LEFT ATRIUM OF HEART : A CLINICAL INSIGHT

Dr. Simriti and Dr. Rekha. Demonstrator, Department of Anatomy, Govt. Medical college Jammu, J & K India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 6 August 2018 Final Accepted: 8 September 2018 Published: October 2018

Pulmonary veins carry oxygenated blood from lungs to the left atrium of heart. The four pulmonary veins open into the superior posterolateral surfaces of the left atrium, two on each side. This typical arrangement is present in 20-60% of the population. The present study was conducted on thirty hearts taken from embalmed male cadavers which were kept for dissection purpose in Government Medical College Jammu. 11(36.66%) hearts showed variations in the pattern of pulmonary veins opening into left atrium out of total hearts studied. The variations in both right and left pulmonary veins were observed in ten hearts (33.33%). Variatons in right pulmonary vein were seen in 10(33.33%) whereas left sided pulmonary veins it was in 11(36.6%) hearts. Variations in the pulmonary veins can be explained on the embryological basis, as these veins develop as a common outgrowth from dorsal atrial wall. As the atria grows, these pulmonary veins get incorporated into the wall of atrium. Thus four separate openings are seen; two on each side of left atrium. Thoracic surgeons should be aware of these variations and meticulous intraoperative confirmation of pulmonary vein anatomy is required while using endoscopic devices. The knowledge about this variation is useful while performing surgeries on left atrium. These variations gain significance in isolation for radiofrequency ablation as a treatment for atrial fibrillation, interventional radiologists and thoracic surgeons before performing procedures which directly or indirectly involve pulmonary veins (Archana goel,et al, 2017). Preprocedural imaging of left atrium and pulmonary veins can offer safety during interventional procedures (Z. Aslı et al, 2014). Earlier, it was considered that the variations in the number and course of pulmonary veins were rare and they were confined only to few case reports (Alfke H et al, 1995). Recently, however, it has been found that variations in pulmonary venous anatomy were seen in 36% of patients (Marom EM et al,2004. It was also observed that it is one of the aetiologies for ectopic heart beats (Tsao HM et al, 2001). The major sources 356 of these ectopic beats appear to be the myocardial sleeves of the distal pulmonary veins which are simple extensions of the left atrial myocardium over the outer surface of pulmonary veins (Tsao HM et al 2000 and Woznaik-Skowerska I et al, 2011). This is the reason why they became a target of interventional cardiology procedures such as catheter radiofrequency pulmonary vein isolation (Chen SA et al, 2000 andGill JS 2004). Knowledge of number of pulmonary veins and their ostia locations is important to ensure that all ostia are ablated, as ectopic foci may go untreated in variant veins. The knowledge of pulmonary vein anomaly could also play a role in new balloon based ablation technology research and development (Kour et al,2017).

Aims and Objectives
The purpose of this study was to evaluate the occurrence of anatomical anomalies of right and left pulmonary veins opening into left atrium on the cadavers and applying this knowledge by cardiothoracic surgeons, who should be aware of these variations while performing intraoperative surgeries and when using endoscopic devices.

Material and Methods:-
The present study was conducted on thirty hearts taken from embalmed male cadavers which were kept for dissection purpose in Government Medical College Jammu. The hearts having severe anatomical defects, hearts on which surgery had been done were not included. The hearts with grafts, heart trauma and were also not included. The number of the pulmonary veins on right side as well as on left side were observed from external aspect and noted down. Percentage of variations found on right and left side was calculated. Percentage of most common variation on both the sides was also calculated. On right side single pattern of pulmonary veins was seen in 6 (20%) hearts, double pattern observed in 20(66.6%) hearts and triple pattern was seen in 4(13.3%) hearts (Figure:2).    (2012) stated that the presence of middle pulmonary vein has been found to produce increased frequency of cardiac arrythimias; atrial fibrillation being the most common. This arrthymia is a cause of significant morbidity and mortality, with the highest risk being sudden cardiac death through heart failure (Taso et al).

Results and Obsevations:-
The anomalous veins can give rise to thrombo-emboli and embolic stroke because of the ectopic beats arising from these veins. Furthermore, atrial fibrillation has been shown to result in atrial remodeling by impacting atrial size (Calkins H et al).

Conclusion:-
Precise knowledge about the variation in number and drainage pattern of pul vns is important for cardiothoracic surgeons and for certain procedures involving radiofrequency ablation, lobectomies, valve replacements, pul vein cathertrization and others. Bibilography:-