Inability to cannulate the coronary sinus in patients with supraventricular arrhythmias: congenital and acquired coronary sinus atresia.
We report 4 cases of congenital and acquired coronary sinus ostial atresia incidentally found during electrophysiologic assessment for supraventricular arrhythmias. Congenital variants consisted of coronary sinus drainage predominantly via persistent left superior vena cavae and partial coronary sinus unroofing into the left atrium. The acquired variant was inadvertently produced during surgery for cor triatriatum. A variety of electrophysiologic substrates including right and left-sided accessory pathways and both typical and atypical AV nodal reciprocating tachycardia were identified. Approaches to imaging and accessing the coronary sinus when the os cannot be cannulated are discussed, including a search for right atrial accessory venous collaterals, venography to rule-out a persistent left superior vena cava, and coronary angiography.
Khairy
Paul
P
Electrophysiology Service, Department of Cardiology, Children's Hospital Boston, Harvard Medical School, USA. pkhairy@cardio.tch.harvard.edu
Triedman
John K
JK
Juraszek
Amy
A
Cecchin
Frank
F
D000293:Adolescent; D000328:Adult; D017115:Catheter Ablation; D002648:Child; D003310:Cor Triatriatum / Q000503:physiopathology* / Q000601:surgery; D022062:Electrophysiologic Techniques, Cardiac; D006329:Heart Conduction System / Q000503:physiopathology*; D006330:Heart Defects, Congenital / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008297:Male; D013617:Tachycardia, Supraventricular / Q000503:physiopathology* / Q000601:surgery
J Thorac Cardiovasc Surg. 1989 Jul;98(1):30-2
2739422
Ann Thorac Surg. 2003 Dec;76(6):2091-2
14667655
Heart. 2000 Sep;84(3):289
10956292
J Cardiovasc Electrophysiol. 2001 Sep;12(9):1080-2
11573701
Ann Thorac Surg. 1996 Mar;61(3):879-82
8619710
Pediatr Cardiol. 1985;6(2):99-101
4059074
J Am Coll Cardiol. 1995 Mar 15;25(4):948-53
7884103
J Thorac Cardiovasc Surg. 2003 Nov;126(5):1655-6
14666054
J Am Soc Echocardiogr. 2002 Sep;15(9):991-3
12221418
Pediatr Cardiol. 1998 Jul-Aug;19(4):352-4
9636261
Clin Cardiol. 2000 Mar;23 (3):149-54
10761800