- Email: [email protected]
Response to “About the origin of the sinus node artery” [Forensic Sci. Int. (2009)]
Forensic Science International 190 (2009) e23
Contents lists available at ScienceDirect
Forensic Science International journal homepage: www.elsevier.com/locate/forsciint
Reply to the Letter to the Editor Response to ‘‘About the origin of the sinus node artery’’ [Forensic Sci. Int. (2009)]
Dear Editor, The interesting comment of the authors [1] raises some remarkable questions concerning our work about the common origin of SN and LCX arteries [2]. Trying to resolve any unclear issues we have to underline the following: First of all we did not describe a combined anatomical abnormality as the authors [1] implied (an underdeveloped LCX with common origin with SN artery). It is obvious in post mortem coronary angiography [2] that the LCX is smaller than the RCA and not in comparison with SN artery. Furthermore our point is not to compare the size between the LCX and SN artery as the authors of ref. [1] incorrectly reported. This is a traditional knowledge and it is not questioned in our report [3,4]. On the contrary, our intention was to stress out the unique finding of the abnormal origin of the SN and LCX with a common trunk from the (LM) coronary artery. In post mortem coronary angiography [2] there are impressive information concerning the course of SN and LCX arteries, but details about their origin are insufficient. In Fig. 1 of the anatomical specimen provided [2] it is clearly shown the LM and the opening of the very short common artery. The 3.1 mm is the length of the common trunk which was subjected to several histopathological procedures (cannulation, resection) and not the proximal segment of the SN artery. As it is shown in this anatomical photo the only possible mistake that someone could have done, was to believe that the LCX originated from the SN but not the opposite. In that case it would be logical to support that 3.1 mm was the length of segment of LCX artery proximal to SN artery and not a common trunk. Finally the growing progress in non-invasive imaging modalities like coronary CT angiography has established their use in pre mortem detection of anomalies involving asymptomatic abnormal origin but
DOI of original article: 10.1016/j.forsciint.2009.06.002 0379-0738/$ – see front matter ß 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.forsciint.2009.06.001
normal course of the coronary arteries which are probably less common than anomalies involving abnormal course [5,6]. However pathology and post mortem coronary angiography allows the precise characterization and accurate identification and description of origin and course of the coronary arteries [7]. References [1] R. De Caro, A. Porzionato, V. Macchi, A. Parenti, About the origin of the sinus node artery, Forensic Sci. Int. 190 (2009) e21. [2] C.E. Nerantzis, G. Gavrielatos, C.A. Lefkidis, P.N. Koutsaftis, A secret pathway of the sinus node artery, Forensic Sci. Int. 186 (2009) e25–e26. [3] T.N. James, Anatomy of the Coronary Arteries, Paul B Heber, New York, 1961, pp. 12–37. [4] E. Nerantzis, D. Avgoustakis, An S-shaped atrial artery supplying the sinus node area. An Anatomical study, Chest 78 (1980) 274–278. [5] L.J. Zhang, Y.Z. Wang, W. Huang, P. Chen, C.S. Zhou, G.M. Lu, Anatomical investigation of the sinus node artery using dual-source computed tomography, Circ. J. 72 (2008) 1615–1620. [6] F. Saremi, A. Abolhoda, O. Ashikyan, J.C. Milliken, J. Narula, S.V. Gurudevan, K. Causal, A. Raney, Arterial supply to sinuatrial and atrioventricular nodes: imaging with multidetector CT, Radiology 246 (2008) 99–109. [7] Nerantzis CE, Gavrielatos G, Kalogrias N, et al. Histological recognition and classification of the atrioventricular node artery variants: a new approach, Cardiovasc. Pathol., Nov 19 2008 (epub ahead of print).
Gerasimos Gavrielatos* Second Department of Cardiology, Evangelismos General Hospital of Q1, 45-47 Ipsilantou St., 10676 Athens, Greece Christos E. Nerantzis Forensic Medical Service of Athens, Mikras Asias 75, 115 27 Athens, Greece *Corresponding author. Fax: +30 2107217687 E-mail address: [email protected] (G. Gavrielatos) Available online 28 June 2009
Contents lists available at ScienceDirect
Forensic Science International journal homepage: www.elsevier.com/locate/forsciint
Reply to the Letter to the Editor Response to ‘‘About the origin of the sinus node artery’’ [Forensic Sci. Int. (2009)]
Dear Editor, The interesting comment of the authors [1] raises some remarkable questions concerning our work about the common origin of SN and LCX arteries [2]. Trying to resolve any unclear issues we have to underline the following: First of all we did not describe a combined anatomical abnormality as the authors [1] implied (an underdeveloped LCX with common origin with SN artery). It is obvious in post mortem coronary angiography [2] that the LCX is smaller than the RCA and not in comparison with SN artery. Furthermore our point is not to compare the size between the LCX and SN artery as the authors of ref. [1] incorrectly reported. This is a traditional knowledge and it is not questioned in our report [3,4]. On the contrary, our intention was to stress out the unique finding of the abnormal origin of the SN and LCX with a common trunk from the (LM) coronary artery. In post mortem coronary angiography [2] there are impressive information concerning the course of SN and LCX arteries, but details about their origin are insufficient. In Fig. 1 of the anatomical specimen provided [2] it is clearly shown the LM and the opening of the very short common artery. The 3.1 mm is the length of the common trunk which was subjected to several histopathological procedures (cannulation, resection) and not the proximal segment of the SN artery. As it is shown in this anatomical photo the only possible mistake that someone could have done, was to believe that the LCX originated from the SN but not the opposite. In that case it would be logical to support that 3.1 mm was the length of segment of LCX artery proximal to SN artery and not a common trunk. Finally the growing progress in non-invasive imaging modalities like coronary CT angiography has established their use in pre mortem detection of anomalies involving asymptomatic abnormal origin but
DOI of original article: 10.1016/j.forsciint.2009.06.002 0379-0738/$ – see front matter ß 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.forsciint.2009.06.001
normal course of the coronary arteries which are probably less common than anomalies involving abnormal course [5,6]. However pathology and post mortem coronary angiography allows the precise characterization and accurate identification and description of origin and course of the coronary arteries [7]. References [1] R. De Caro, A. Porzionato, V. Macchi, A. Parenti, About the origin of the sinus node artery, Forensic Sci. Int. 190 (2009) e21. [2] C.E. Nerantzis, G. Gavrielatos, C.A. Lefkidis, P.N. Koutsaftis, A secret pathway of the sinus node artery, Forensic Sci. Int. 186 (2009) e25–e26. [3] T.N. James, Anatomy of the Coronary Arteries, Paul B Heber, New York, 1961, pp. 12–37. [4] E. Nerantzis, D. Avgoustakis, An S-shaped atrial artery supplying the sinus node area. An Anatomical study, Chest 78 (1980) 274–278. [5] L.J. Zhang, Y.Z. Wang, W. Huang, P. Chen, C.S. Zhou, G.M. Lu, Anatomical investigation of the sinus node artery using dual-source computed tomography, Circ. J. 72 (2008) 1615–1620. [6] F. Saremi, A. Abolhoda, O. Ashikyan, J.C. Milliken, J. Narula, S.V. Gurudevan, K. Causal, A. Raney, Arterial supply to sinuatrial and atrioventricular nodes: imaging with multidetector CT, Radiology 246 (2008) 99–109. [7] Nerantzis CE, Gavrielatos G, Kalogrias N, et al. Histological recognition and classification of the atrioventricular node artery variants: a new approach, Cardiovasc. Pathol., Nov 19 2008 (epub ahead of print).
Gerasimos Gavrielatos* Second Department of Cardiology, Evangelismos General Hospital of Q1, 45-47 Ipsilantou St., 10676 Athens, Greece Christos E. Nerantzis Forensic Medical Service of Athens, Mikras Asias 75, 115 27 Athens, Greece *Corresponding author. Fax: +30 2107217687 E-mail address: [email protected] (G. Gavrielatos) Available online 28 June 2009