CRT devices have at least two leads, one passing through the " vena cava " and the right atrium into the right ventricle to stimulate the septum, and another passing through the " vena cava " and the right atrium and inserted through the coronary sinus to pace the epicardial wall of the left ventricle.
32.
Besides Bachmann's bundle, the other three conduction tracts that constitute the " atrial conduction system " are known as the anterior, middle, and posterior tracts, which run from the sinoatrial node to the atrioventricular node, converging in the region near the coronary sinus . " Atrial automaticity foci " are within the atrial conduction system.
33.
There are four variants : Supracardiac ( 50 % ) : blood drains to one of the innominate veins ( brachiocephalic veins ) or the superior vena cava; Cardiac ( 20 % ), where blood drains into coronary sinus or directly into right atrium; Infradiaphragmatic ( 20 % ), where blood drains into portal or hepatic veins; and a mixed ( 10 % ) variant.
34.
It is formed by the folding of the serous layer over the remnant of the lower part of the left superior vena cava ( duct of Cuvier ), which becomes obliterated during fetal life, and remains as a fibrous band stretching from the highest left intercostal vein to the left atrium, where it is continuous with a small cardiac vein, the vein of the left atrium ( oblique vein of Marshall ), which opens into the coronary sinus.
35.
It may appear similar to a diaphragm or be funnel-shaped, bandlike, entirely intact ( imperforate ) or contain one or more openings ( fenestrations ) ranging from small, restrictive-type to large and widely open . In the pediatric population, this anomaly may be associated with major congenital cardiac lesions such as tetralogy of Fallot, double outlet right ventricle, coarctation of the aorta, partial anomalous pulmonary venous connection, persistent left superior vena cava with unroofed coronary sinus, ventricular septal defect, atrioventricular septal ( endocardial cushion ) defect, and common atrioventricular canal.
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