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Abstract
Introduction. The sinoatrial node (SAN) is vascularized by the sinoatrial nodal artery (SANa) and drained by the sinoatrial nodal vein (SANv). Precise knowledge of the origin and drainage patterns is essential for cardiac surgery and interventional procedures. This study aimed to characterize anatomical variations of the SANa origin, describe the venous drainage of the SAN, and identify clinical implications in black African subjects. Methods. The study took place in the University Teaching Hospital of Bouake. It was a combined macroscopic and histological study on 33 human anatomical specimens using vascular injection techniques. We injected blue dye into the right coronary artery (RCA), red dye into the left coronary artery (LCA), and green dye into the coronary sinus. We then examined the sinoatrial node area macroscopically and histologically (10 hearts) using standard staining (HES). Results. The SANa originated from the RCA in 20 cases (60.60%), from the LCA in 11 cases (33.33%), and from both coronary arteries in 2 cases (6.06%). The venous drainage of the SAN was not consistently dependent on the coronary sinus; in several specimens, the SANv drained directly into the right atrium or via small cardiac veins independent of the coronary sinus. Histological examination confirmed the presence of dye within the SAN tissue, validating the injection technique. Conclusion. In the Ivorian black subjects, the vascularization of the human SAN demonstrates significant anatomical variability in both arterial origin and venous drainage. RCA dominance is most common, but LCA and dual supply occur in over one‑third of cases. Venous drainage does not always involve the coronary sinus. These variations have important implications for cardiac surgery (avoiding SAN ischemia) and for understanding arrhythmogenesis.
RÉSUMÉ
Introduction. Le nœud sino‑auriculaire (NSA) est vascularisé par l’artère du nœud sino‑auriculaire (ANSA) et drainé par la veine du nœud sino‑auriculaire (VNSA). La connaissance précise de l’origine artérielle et du mode de drainage veineux est essentielle en chirurgie cardiaque et en rythmologie. Cette étude a caractérisé les variations anatomiques de l’origine de l’ANSA, décrit le drainage veineux du NSA et identifié les implications cliniques dans une population noire africaine. Méthodes. L’étude a eu lieu au CHU de Bouake sur des sujets noirs ivoiriens. Il s’agit d’une étude combinée macroscopique et histologique sur 33 pièces anatomiques humaines en utilisant des techniques d’injection vasculaire. Nous avons injecté un colorant bleu dans l’artère coronaire droite (ACD), un colorant rouge dans l’artère coronaire gauche (ACG) et un colorant vert dans le sinus coronaire. Nous avons ensuite examiné la région du nœud sino‑auriculaire macroscopiquement et histologiquement (10 cœurs) après coloration standard (HES). Résultats. L’ANSA provenait de l’ACD dans 20 cas (60,60 %), de l’ACG dans 11 cas (33,33 %) et des deux artères coronaires dans 2 cas (6,06 %). Le drainage veineux du NSA ne dépendait pas systématiquement du sinus coronaire ; dans plusieurs spécimens, la VNSA se drainait directement dans l’oreillette droite ou par de petites veines cardiaques indépendantes du sinus coronaire. L’examen histologique a confirmé la présence du colorant dans le tissu nodal, validant la technique d’injection. Conclusion. Chez le sujet noir ivoirien, la vascularisation du nœud sino‑auriculaire humain présente une variabilité anatomique importante, tant pour l’origine artérielle que pour le drainage veineux. La dominance par l’ACD est la plus fréquente, mais une origine par l’ACG ou double survient dans plus d’un tiers des cas. Le drainage veineux n’implique pas toujours le sinus coronaire. Ces variations ont des implications majeures en chirurgie cardiaque (prévention de l’ischémie du NSA) et pour la compréhension des arythmies.
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References
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- 8. Meneas GC, Yangni-Angate KH, Abro S, Adoubi KA Location of the Human Sinus Node in Black Africans. Anat Physiol. 2017 ;7: 279.
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- 14. Busquet J, Fontan, Anderson RH, Ho Sy, Davies MJ. The surgical significance of the atrial branches of the coronary arteries. Int J Cardiol. 1984;6: 223-26.
- 15. Sow ML, Ndoye JM, Lo EA. The artery of the sinu-atrial node: anatomic considerations based on 45 injection-dissections of the heart. Surg Radiol Anat. 1996;18:103-9.
- 16. Pejkovic B, Krajnc I, Anderhuber F, Kosutic D. Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart.
- 17. J Int med Res. 2008;36:691-8.
- 18. Nerantzis C, Avgoustakis D. An S-Shaped atrial artery supplying the sinus node area. An anatomical study. Chest. 1980;78:274-8.
- 19. Kyriakidis M, Vyssoulis G, Barbe-tseas J, Toutouzas P. A clinical angio-graphic study of the arterial blood supply to the sinus node. Chest. 1988;94: 1054-7.
- 20. Didio LJ, Lopes AC, Caetano AC, Prates JC. Variations of the origin of the artery of the sino atrial node in the normal human hearts. Surg Radiol anat. 1995;17: 19-26.
- 21. Eliska O and Elisko M. Venous circulation of the human cardiac conduc-tion system. Br Heart J. 1979;42: 508-13.
- 22. Lekieffre J, Medvedowsky J L, Thery C. Le nœud sinusal normal et pathologique. Sandoz. 1979;212p.
- 23. Shumway N E, R R Lower. Topical cardiac hypothermia for extended periods of anoxic arrest. Surgical forum.1960;10 :563-6.
- 24. Cross Fs, Jones RD, Berne RM. Localized cardiac hypothermia as an adjunct to elective cardiac arrest. Surg Forum. 1957;8:355-9.
- 25. Beyazal OF, Yazici S, Temizturk Z, Aydin C, Tezcan H, Citak SS, Kayalar N, Yanartas M. Should Topical Ice Slush Be Used Routinely in Cardiac Surgery? Topical Ice Slush in Cardiac Surgery. J Clin Med. 2025; 14:6980.
References
1. Vikse J, Henry BM, Roy J, Ramakri-shnan PK, Hsieh WC, Walocha JA, et al. Anatomical Variations in the Sinoatrial Nodal Artery: A Meta- Analysis and Clinical Considerations. PLoS ONE. 2016;11:e0148331.
2. Eliska O And Elisko M. Venous circulation of the human cardiac con-duction system. British Heart Journal. 1979;42:508-13.
3. Yangni–Angate H, Kokoua A, Kouassi R, Kassanyou S, Gnagne Y, Nguessan G, et al. Coronary veins and tributary veins of the African coronary sinus. West African journal of Medicine. 1995;14:161- 4.
4. Iaizzo P. Handbook of cardiac anatomy, physiology, and devices. 2nd ed. Springer; 2009.
5. Gaudino M, Nasso G, Minati A, Salica A, Luciani N, Morelli M, et al. Early and late arrhythmias in patients in preoperative sinus rhythm submitted to mitral valve surgery through the superior septal approach. Ann Thorac Surg. 2003; 75:1181-4.
6. Berdajs D, Patonay L, Turina M. The clinical anatomy of the sinus node artery. Ann Thorac Surg. 2003;76:732–5.
7. Fornes P. L’examen Anatomo-pathologique du cœur = Dissection method for the adult heart and gross examination. Ann Pathol. 1999;19:173-4.
8. Meneas GC, Yangni-Angate KH, Abro S, Adoubi KA Location of the Human Sinus Node in Black Africans. Anat Physiol. 2017 ;7: 279.
9. Christides C, Cabrol C. Anatomie des artères coronaires du cœur. Editions J. B. Baillière (Paris). 1976;1:87-96.
10. KRUPA U. The sinu-atrial node artery in the human heart. Folia morphol (Warsz). 1993; 52: 29-37.
11. Yangni-Angate H, Kouassi R, Kokoua A, Kassanyou S, Gnagne Y, N’guessan G, et al. Vascularization of the sinus node in the black African. Wes Afr J Med. 1995;14:181-3.
12. Onciu M, Tutala, Baz R, Leonte T.
13. Specifics of the blood supply of sino-atrial node. Rev Med Chir Soc Med Nat Lasi. 2006;110:667-73.
14. Busquet J, Fontan, Anderson RH, Ho Sy, Davies MJ. The surgical significance of the atrial branches of the coronary arteries. Int J Cardiol. 1984;6: 223-26.
15. Sow ML, Ndoye JM, Lo EA. The artery of the sinu-atrial node: anatomic considerations based on 45 injection-dissections of the heart. Surg Radiol Anat. 1996;18:103-9.
16. Pejkovic B, Krajnc I, Anderhuber F, Kosutic D. Anatomical aspects of the arterial blood supply to the sinoatrial and atrioventricular nodes of the human heart.
17. J Int med Res. 2008;36:691-8.
18. Nerantzis C, Avgoustakis D. An S-Shaped atrial artery supplying the sinus node area. An anatomical study. Chest. 1980;78:274-8.
19. Kyriakidis M, Vyssoulis G, Barbe-tseas J, Toutouzas P. A clinical angio-graphic study of the arterial blood supply to the sinus node. Chest. 1988;94: 1054-7.
20. Didio LJ, Lopes AC, Caetano AC, Prates JC. Variations of the origin of the artery of the sino atrial node in the normal human hearts. Surg Radiol anat. 1995;17: 19-26.
21. Eliska O and Elisko M. Venous circulation of the human cardiac conduc-tion system. Br Heart J. 1979;42: 508-13.
22. Lekieffre J, Medvedowsky J L, Thery C. Le nœud sinusal normal et pathologique. Sandoz. 1979;212p.
23. Shumway N E, R R Lower. Topical cardiac hypothermia for extended periods of anoxic arrest. Surgical forum.1960;10 :563-6.
24. Cross Fs, Jones RD, Berne RM. Localized cardiac hypothermia as an adjunct to elective cardiac arrest. Surg Forum. 1957;8:355-9.
25. Beyazal OF, Yazici S, Temizturk Z, Aydin C, Tezcan H, Citak SS, Kayalar N, Yanartas M. Should Topical Ice Slush Be Used Routinely in Cardiac Surgery? Topical Ice Slush in Cardiac Surgery. J Clin Med. 2025; 14:6980.