Real Time Three‐Dimensional Transesophageal Echocardiography Guided Coronary Sinus Cannulation during CARILLON Mitral Annuloplasty Device Therapy for a Patient with Chronic Severe Mitral Regurgitation

Abstract

The coronary sinus (CS) has become a clinically important structure especially through its role in providing access for different cardiac procedures such as arrhythmia ablation, biventricular pacing and recently, percutaneous valvular interventions. Fluoroscopy with or without two-dimensional transesophageal echocardiography is the widely used method for guidance. A 78-year-old female patient undergoing percutaneous CARILLON mitral annuloplasty device therapy for chronic severe symptomatic mitral regurgitation. After insertion of the CS catheter through the right internal jugular vein, multiple trials for CS cannulation guided by fluoroscopy and two-dimensional transesophageal echocardiography were unsuccessful. So, real time three-dimensional zoom mode was used. Then, the volume was rotated to have the anatomically oriented enface view of the interatrial septum from the right atrial perspective. The CS ostium was identified adjacent to the eustachian valve. Then the catheter was reintroduced through the superior vena cava into the right atrium then easily navigated to cannulate the CS ostium. The position was confirmed by the fluoroscopically known course of the CS plus the pattern of the invasive pressure wave form. CS cannulation is not always feasible using fluoroscopy and/or two-dimensional Echocardiography guidance. Real time three-dimensional transesophageal echocardiography can be used to guide CS cannulation as it provides an anatomically oriented and informative enface view of the CS ostium. It can help reducing fluoroscopic radiation time.

Three-dimensional visualisation of coronary sinus ostium from the inside right atrium perspective

“…However, there is one description of using 3D echocardiography to cannulate the CS. Mahmoud et al [22] presented a case of a 78-year-old patient in whom a CARILLON, which is a device for percutaneous mitral annuloplasty, was implanted. The use of fluoroscopy and 3D transoesophageal echocardiography for CS cannulation was unsuccessful.…”

A Proposed Maneuver to Guide Transseptal Puncture Using Real-Time Three-Dimensional Transesophageal Echocardiography: Pilot Study

“…The anatomically oriented en face view for the IAS from the RA perspective was described before for the purpose of delineating the anatomy of atrial septal defects [ 6 ]. It was also reported by us to be used for guiding coronary sinus CS cannulation in percutaneous mitral annuloplasty using CS ring [ 7 ].…”

Role of imaging in novel mitral technologies—echocardiography and computed tomography

“…The residual regurgitation evaluation is limited to semi-quantitative color Doppler data, as PISA method is not validated for double orifices and jets. The impact of a persistent (30,31). Carillon ® is deployed into the coronary sinus via transjugular approach, then the device is anchored near the antero-lateral commissure, followed by plication of the peri-annular tissue, without general anesthesia, in FMR patients.…”