Congenital Anomalies Involving the Coronary Sinus

Mantini, Emil L.; Grondin, Claude M.; Lillehei, C. Walton; Edwards, Jesse E.

doi:10.1161/01.cir.33.2.317

Cited by 189 publications

(114 citation statements)

References 13 publications

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“…1 Interatrial septal defects and persistent left superior vena cava are usually associated. The case reported here would correspond to the second type with an associated left superior vena cava.…”

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confidence: 99%

Total Coronary Vein–Left Atrial Drainage

et al. 2009

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A n asymptomatic 54-year-old man with severe mitral regurgitation caused by prolapse and pulmonary hypertension was referred for mitral valve surgery. The resting ECG ( Figure 1) and chest radiograph ( Figure 2) were unremarkable. A transesophageal echocardiogram showed a degenerated mitral valve with rupture of chordae tendineae and leaflet prolapse causing severe mitral regurgitation (Figure 3).Preoperative computed tomographic coronary angiography demonstrated normal coronary arteries; however, all cardiac veins were found to drain into the left atrium (Figures 4 and 5). The great cardiac vein and a small persistent left superior vena cava connected to a remnant of the coronary sinus (CS). Complete absence of the sinoatrial wall was noted, and this remnant CS drained directly into the left atrium. The posterior interventricular vein and the middle and small cardiac veins drained through a dilated common conduit into the posterior region of the left atrium. The posterior vein of the left ventricle had an independent ostium that entered the left atrium. The atrial situs was solitus, with normal morphology of both left and right appendages.The patient underwent mitral valve repair (Figure 6). On the basis of the results of the computed tomographic coronary angiography, during the surgery, only anterograde cardioplegia was used, and the persistent left superior vena cava was not ligated. A postoperative transesophageal echocardiogram showed the blood flow from the remnant of the CS entering the left atrium ( Figure 7) and a normal-functioning mitral valve (Figure 8). The postoperative course was uneventful, and the patient was discharged.Four types of CS abnormalities have been described: Enlarged CS, absence of CS, hypoplasia of CS, and atresia of the right atrial CS ostium. 1 Interatrial septal defects and persistent left superior vena cava are usually associated. The case reported here would correspond to the second type with an associated left superior vena cava. A similar case has been described previously with the hypothesis of a cardinal vein isomerism as the cause of the defect 2 ; however, the drainage of all of the coronary veins into the left atrium and the absence of other congenital heart defects make this a unique case.

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Total Coronary Vein–Left Atrial Drainage

et al. 2009

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“…It is found in 0.3%-0.5% of the general population and 3%-10% of patients with congenital heart disease. 3,4 In itself, it causes no hemodynamic disturbance, because it harmlessly drains into the right atrium via the coronary sinus. 4,5 It usually occurs in association with a normal right-sided superior vena cava.…”

Section: Discussionmentioning

confidence: 99%

“…It is found in 0.3%-0.5% of the general population and 3%-10% of patients with congenital heart disease. 3,4 In itself, …”

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Permanent Pacing of the Heart Via a Coronary Sinus Branch

1998

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A Al-Khadra, S Al-Awami, A El-Hassan, Permanent Pacing of the Heart Via a Coronary Sinus Branch. 1998; 18(4): 347-348 Transvenous right ventricular endocardial pacing has become the routine method of cardiac pacing among most surgeons. Lead placement in the coronary sinus is sometimes encountered, but usually promptly recognized and corrected. Conversely, in the presence of a congenital venous anomaly, electrode placement in a cardiac vein may not be easily recognized, as it mimics right ventricular apical position.1 The course of a long-term pacing from a cardiac vein is not known. We report here a case of a persistent left superior vena cava (PLSVC) in which a pacing lead via the left subclavian vein was inadvertently placed in a tributary of the coronary sinus, with effective cardiac pacing for two years. Case ReportA 60-year-old Saudi man was admitted with a four-week history of dizziness. There was no history of palpitation or chest pain. He had been diagnosed with hypertension and bronchial asthma five years prior to presentation, and diabetes mellitus type II a year later. The patient was on enalapril and salbutamol inhaler. His diabetes mellitus was controlled by diet. He stopped taking the enalapril a month prior to his presentation after he linked it with the development of dizzy spells.On examination, the patient was conscious and alert. His blood pressure was 160/90 mm Hg, while the pulse was 80/min with occasional irregularity. Chest examination showed a barrel-shaped chest with coarse crepitations scattered all over. No ronchi were heard. The rest of the physical examination was normal.A Holter monitor showed several sinus pauses, the longest of which was 2.5 sec. Two short episodes of paroxysmal supraventricular tachycardia were also recorded. Blood urea nitrogen, creatinine and serum electrolytes, and blood sugar were normal. A corrected sinus node recovery time of 2040 msec was recorded (normal <525 msec) 2 after the insertion of a temporary pacemaker via the right femoral vein. The patient was taken to the operating room where, under local anesthesia, a transverse skin incision at the inferior border of the left clavicle was made and a pocket to host the pulse generator was created between the pectoral's major muscle and the pre-pectoral fascia. Through the same incision, the left subclavian vein was punctured, and using Seldinger's technique, a transvenous lead was introduced. An image intensifier was used to direct the pacing lead to the apex of the right ventricle. It was difficult to position the lead at the apex of the right ventricle, as the tip of the lead tended to deflect away from the tricuspid orifice. After repeated trials and after ensuring that the threshold for pacing (1 mv) and the ability of the pacemaker to sense were good, the lead was left in this functional, though not ideal position. Valsalva's maneuver did not displace the tip of the lead.Postoperative ECG showed a normally functioning pacemaker but a QRS (the principal deflection in an electrocardiogram) with RBBB (r...

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“…Mantini's et al proposed four categories of CS anomalies as enlarged CS, absent CS, atresia of the right atrial CS ostium and hypoplasia of the CS [2]. The enlarged CS category has two subtypes-subtype A (without left-to-right shunt) and subtype B (with left-to-right shunt).…”

Section: Review Of Literaturementioning

confidence: 99%

Coronary Sinus Atrial Septal Defect (Unroofed Coronary Sinus) with Total Anomalous Pulmonary Venous Connection—A Case Report

Muthiah¹

2017

CRCM

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Introduction: To present a rare occurrence of coronary sinus atrial septal defect (ASD) associated with total anomalous pulmonary venous connection (TAPVC). Case Report: A 16-year-old girl was diagnosed with features of an atrial septal defect (ASD) by transthoracic echocardiography and the absence of PLSVC (persistent left superior vena cava) connection to coronary sinus was confirmed by saline contrast echocardiography ("bubble study"). Discussion: The cause of the dilated coronary sinus was due to total anomalous pulmonary venous connection. Conclusion: Coronary sinus atrial septal defect (ASD) is a rare interatrial shunt that is commonly associated with a persistent left superior vena cava (PLSVC) and occurs in less than 1% of cases of ASDs. It is characterized by the absence of at least a portion of the common wall that separates the coronary sinus and left atrium. Isolated defects are associated with low rate of morbidity and mortality.

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Congenital Anomalies Involving the Coronary Sinus

Cited by 189 publications

References 13 publications

Total Coronary Vein–Left Atrial Drainage

Total Coronary Vein–Left Atrial Drainage

Permanent Pacing of the Heart Via a Coronary Sinus Branch

Coronary Sinus Atrial Septal Defect (Unroofed Coronary Sinus) with Total Anomalous Pulmonary Venous Connection—A Case Report

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