Atresia of coronary sinus ostium with retrograde drainage via persistent left superior vena cava

Jha, Neerod Kumar; Gogna, Apoorva; Tan, Teng Hong; Wong, Keng Yean; Shankar, Sriram

doi:10.1016/s0003-4975(03)01040-3

Cited by 39 publications

(40 citation statements)

References 5 publications

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“…Coronary sinus ostial atresia is a rare entity known to be associated with a variety of congenital heart diseases. [1][2][3][4][5][6] Until now, its association with obstructed TAPV drainage has not been reported.…”

Section: Discussionmentioning

confidence: 99%

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Venous Myocardial Infarction in an Infant with Obstructed Totally Anomalous Pulmonary Venous Drainage and Coronary Sinus Ostial Atresia

Prasad¹,

Strainic²,

Pandya³

et al. 2016

Texas Heart Institute Journal

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C oronary sinus (CS) ostial atresia is a rare entity, known to be associated with a variety of congenital heart diseases. [1][2][3][4][5][6] Generally, an anomalous decompressing vein drains the coronary venous blood. Any obstruction in the path of coronary venous drainage can lead to coronary venous hypertension and myocardial infarction (MI). We report a case of obstructed totally anomalous pulmonary venous (TAPV) return with CS ostial atresia, which led to venous MI. This, to our knowledge, has never before been reported. Case ReportIn March 2013, a 12-week-old girl with a history of failure to thrive presented in extremis with cardiogenic shock. Her physical examination showed that she had tachypnea, poor systemic perfusion, cyanosis, and bibasilar rales. An emergency echocardiogram revealed a membranous obstruction at the junction of the brachiocephalic vein and the superior vena cava (Fig. 1) and TAPV drainage of a supracardiac type-together with a dilated CS, a large atrial septal defect with right-to-left shunting, and pulmonary hypertension.Emergency cardiac catheterization, performed to relieve the obstruction, confirmed the presence of TAPV drainage through a vertical vein into the left brachiocephalic vein, which was obstructed at its junction with the right superior vena cava (gradient, 19 mmHg). This CS ostial atresia resulted in severe pulmonary hypertension and retrograde drainage, via a connecting vein, to the pulmonary venous confluence (Fig. 2). Balloon angioplasty at the site of the obstructive membrane substantially relieved the hypertension.During the procedure, the patient developed sustained monomorphic ventricular tachycardia secondary to an MI, as evidenced by troponin levels elevated to 130 ng/mL and by diffuse ST-segment changes on electrocardiogram. The infarction was most likely associated with the transient elevation of coronary pressure upon balloon inflation.The patient was noted on her echocardiogram to have global qualitative left ventricular dysfunction, and her myocardial function recovery was closely observed in the intensive care unit. Her cardiac enzyme levels returned to baseline, and her left ventricular function improved substantially. A cardiac computed tomogram, obtained a week later to better delineate the postoperative pulmonary venous anatomy, confirmed the above findings (Fig. 3).Two weeks later, the patient underwent surgical repair, which comprised anastomosis of the venous confluence to the left atrium, unroofing of the CS to the left atrium, ligation of the vertical vein and the connecting vein from the CS to the confluence,

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Generally, an anomalous decompressing vein drains the coronary venous blood. Any obstruction in the path of coronary venous drainage can lead to coronary venous hypertension and myocardial infarction (MI).…”

mentioning

confidence: 99%

Venous Myocardial Infarction in an Infant with Obstructed Totally Anomalous Pulmonary Venous Drainage and Coronary Sinus Ostial Atresia

Prasad¹,

Strainic²,

Pandya³

et al. 2016

Texas Heart Institute Journal

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“…If the patient was suffering from the AVNRT, lesion of slow pathway region would be familiar. Second, in the presence of this anomaly, particularly the PLSVC may be arrhythmogenic due to its intricate relation with the ligament of Marshall and a dilated CS [7]. Both conditions are known to favor arrhythmogenesis.…”

Section: Discussionmentioning

confidence: 99%

Successful left-sided accessory pathway ablation without reference catheter in patient with atresia of coronary sinus and thin persistent left superior vena cava

Chen¹,

Xu²,

Cheng³

et al. 2013

CRCM

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We report a case of atrioventricular reentrant tachycardia (AVRT) with ostial atresia of the coronary sinus (CS). Without the anatomic angiography, radiofrequency (RF) energy was applied at the mitral valve annulus and the bypass tract was eliminated. After the therapy procedure, by CS angiography, we knew the persistent left superior vena cava (PLSVC), and the coronary sinus was connected with vena cava superior, very thin in a diameter. The therapy procedure was successful. The patient has remained completely symptom free.

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“…When this ostium is not present, this is a rare congenital anomaly named atresia of the CS ostium (Zimand et al, 1999;Jha et al, 2003), considered one of the most rare congenital anomalies of the thoracic circulatory system (Bhatti et al, 2007;Stylianou et al, 2007). This anomaly is commonly associated with others of the cardiocirculatory system, including those of the heart itself (Santoscoy et al, 1996;AlexiMeskishvili et al, 1999).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, with this anomaly, an important dilation of the CS develops and might be responsible for organic dysfunctions such as myocardial congestion and heart dilation (Zimand et al;Kuppusamy & Balogun, 2004;Jha et al). These entities are known to be associated to syncope, dyspnea, arrhythmia and Wolff Parkinson White syndrome (Bhatti et al).…”

Section: Introductionmentioning

confidence: 99%

Atresia of the Coronary Sinus Ostium to the Right Atrium with a Persistent Left Superior Vena Cava

et al. 2009

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SUMMARY:The coronary sinus has lately assumed an important role in the cardiologic clinic once it has been widely used in invasive procedures of the heart. Commonly, it is used during the electrodes implants for the epimiocardic monitoring of the cardiac rhythm, through a biventricular pace maker. These invasive procedures are not possible in hearts with an atresic coronary sinus ostium. In the presence of this anomaly, another may occur: the development of the "Marchal" vein which is a remaining of the left superior vena cava (LSVC). This happens so that the venous blood from the heart can drain into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. The presence of a LSVC brings difficulties when performing an invasive procedure in order to access the right atrium through the superior vena cava, usually done in the cardiologic clinic. Moreover, the LSVC crossing over the left atrium is vulnerable to cardiovascular surgical interventions, confirmed by clinical reports. In the present study, 400 formalin fixed hearts from male cadavers, aged between 35 and 80 years, were investigated, particularly for the anatomy of the coronary sinus. The obliterated ostium of the coronary sinus to the right atrium associated with a persistent LSVC was present in only one (0.25%). We performed a diameter study of these structures since they were dilated due to the venous blood from the heart draining into the right atrium, by a communication between the LSVC and the left brachiocephalic vein. We also perform a literature review of these cases and discuss our finding in relation to its clinical importance.

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Atresia of coronary sinus ostium with retrograde drainage via persistent left superior vena cava

Cited by 39 publications

References 5 publications

Venous Myocardial Infarction in an Infant with Obstructed Totally Anomalous Pulmonary Venous Drainage and Coronary Sinus Ostial Atresia

Venous Myocardial Infarction in an Infant with Obstructed Totally Anomalous Pulmonary Venous Drainage and Coronary Sinus Ostial Atresia

Successful left-sided accessory pathway ablation without reference catheter in patient with atresia of coronary sinus and thin persistent left superior vena cava

Atresia of the Coronary Sinus Ostium to the Right Atrium with a Persistent Left Superior Vena Cava

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