Duplicated coronary sinus with a connecting branch

T. Yamada, H. T. McElderry, V. J. Plumb, H. Doppalapudi, A. E. Epstein, G. N. Kay
2008 Europace  
A 48-year-old woman with class III heart failure and left bundle branch block underwent an implantation for cardiac resynchronization therapy. Right anterior oblique (RAO) view coronary sinus (CS) venography suggested the antero-and postero-lateral branches appeared to arise from the same vessel of a duplicated CS, but the antero-lateral branch arising from a different vessel was visualized via a connecting branch by the contrast injected into the vessel with the postero-lateral branch, and the
more » ... ral branch, and the distal parts of the two vessels were superimposed in the RAO view. This unusual anomaly may have the potential risk for complications such as perforations. Implantation of a cardiac resynchronization therapy (CRT) device with a defibrillator was recommended for a 48-year-old woman with ischaemic cardiomyopathy, a left ventricular (LV) ejection fraction of 25%, New York Heart Association Class III heart failure, and left bundle branch block. She had undergone coronary bypass surgery and mitral valvoplasty. In a balloon-occluded coronary sinus (CS) venogram in the right anterior oblique (RAO) view, the antero-lateral (solid star) and postero-lateral (open star) branches appeared to arise from the same vessel in the venography, but a duplicated CS (white arrowheads) with a connecting branch was suggested in the late phase ( Figure 1A and B) . During the implantation of the LV lead, the antero-lateral branch was considered as a preferable choice of the target vein because the postero-lateral branch had an acute take off and small lumen. However, the guidewire could not be advanced to the target site. A balloon-occluded CS venogram was then performed in the left anterior oblique view and revealed that a branch (dotted arrows) connected the two vessels and the antero-and postero-lateral branches arose from different vessels ( Figure 1D ). When the balloon was deflated during the contrast injection, a simultaneous visualization of the proximal portions of the two vessels was achieved and it revealed that the two vessels had a common ostium (black Figure 1 Coronary sinus venograms (A, B, D, and E) and left ventricular lead positions (C and F ). (A) Early phase; (B) late phase; (D) with the balloon occlusion; and (E) without the balloon occlusion. The solid and open stars indicate the antero-and postero-lateral branches, respectively, white arrowheads a duplicated coronary sinus, dotted arrows a connecting branch, and black arrowheads a common ostium. Published on behalf of the
doi:10.1093/europace/eun088 pmid:18417500 fatcat:xf2pgvs2fra75lpivi3vf3ksk4