45 Feasibility of cardiac CT for detecting the optimum coronary sinus branch in cardiac resynchronized therapy

Abstract Background Unroofed coronary sinus (UCS) is a rare congenital cardiac anomaly in which there is complete or partial absence of the roof of the coronary sinus (CS) resulting in a communication between the right and left atria. There are four types of UCS described in the literature. While usually asymptomatic and discovered incidentally on imaging, UCS can be the source of a brain abscess or paradoxical embolism. Case summary A 62-year-old gentleman presented to the emergency department with sudden onset of right-sided weakness and subsequent unresponsiveness. His brain computed tomography (CT) was consistent with left-sided stroke. Transthoracic echocardiography was remarkable for a dilated CS and an agitated saline study was suggestive of an UCS. A gated cardiac CT with coronary angiography confirmed a wide communication between the CS and left atrium. Right heart catheterization did not show evidence of left to right shunt. He had no abnormal rhythm on telemetry monitoring throughout his hospital stay. Discussion Unroofed coronary sinus is the least prevalent form of an atrial septal defect. Unroofed coronary sinus is usually asymptomatic and is diagnosed incidentally in imaging studies, however, it should be suspected in patients with cerebral emboli or evidence of left to right shunt with unexplained arterial desaturation. Transthoracic echocardiography is the most widely used imaging modality for the diagnosis of UCS but is limited in its ability to visualize the posterior cardiac structures such as the CS and pulmonary veins. Gated cardiac CT is a great diagnostic tool for UCS.

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A Case of Coronary Sinus Atresia with a Total Anomalous Cardiac Venous Drainage to the Left Atrium without Persistent Left Superior Vena Cava: Imaging Findings on Cardiac CT

Journal of the Korean Society of Radiology ◽

10.3348/jksr.2020.0104 ◽

2021 ◽

Vol 82 ◽

Author(s):

Sang Hun Baek ◽

Eun-Ju Kang ◽

Ki-Nam Lee

Keyword(s):

Left Atrium ◽

Superior Vena Cava ◽

Coronary Sinus ◽

Cardiac Ct ◽

Superior Vena ◽

Vena Cava ◽

Venous Drainage ◽

Imaging Findings ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena

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Abstract 15482: Variation in Right Atrial Sizes Affects Locations of the His Bundle and Coronary Sinus Os

Circulation ◽

10.1161/circ.142.suppl_3.15482 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Chin C Lee ◽

Michael Eskander ◽

Katherine Lowe ◽

Jonathan Chung ◽

Jonathan Hsu ◽

...

Keyword(s):

Coronary Sinus ◽

Cardiac Ct ◽

Superior Vena ◽

Vena Cava ◽

Right Atrial ◽

Volume Index ◽

Electroanatomic Mapping ◽

His Bundle ◽

The Mean ◽

Delivery Sheath

Background: Difficulties in HIS bundle (HBP) and coronary sinus (CS) lead delivery may be contributed by differences in right atrial (RA) anatomy. The distance from the lateral superior vena cava / right atrial junction (SVC) to the HIS bundle or CS os reflects the distance required by a delivery sheath to reach the cannulation target. However, RA geometry is not well characterized using standard 2D echo, but is well characterized by cardiac computed tomography (CT) and invasive electroanatomic mapping (EAM). Objective: The objective of this study is to characterize the variations in the distance from the SVC-RA JXN to the 1) HIS bundle and 2) coronary sinus os, and determine the correlation of these distances to standard measurements obtained from 2D echo. Methods: Cardiac CT (256 slice), electroanatomic maps, and 2D echo from patients undergoing ablation for atrial and ventricular arrhythmias were analyzed using 3D modeling software (Horos). The distances from the SVC were measured to the HIS and CS os on the CT which were co-registered to electroanatomic mapping (Fig 1A). Pearson’s coefficient analysis was performed to assess the correlation of these RA measurements with standard left-sided 2D echo measurements. Results: 41 patients (age 6210 yrs, 31% female, 69% AF ablation) were analyzed. The mean distance between SVC-HIS was 37.2 mm 8.3 mm (range 22-56mm), and the mean distance between SVC-CS os was 66.1 mm 10.1 mm (range 49-92mm), Fig 1B. Both RA measurements correlated (Fig 1B) with LA volume index (R=0.6, p<0.001) but not LV diameter (R=0.079, p=0.3). Conclusion: The distance from the SVC/RA JXN to the HIS and CS os varies widely and may contribute to difficulties in HIS bundle and CS lead implantation. In the absence of pre-procedural cardiac CT or EAM, left atrial measurements from 2D echo may correlate with RA dimensions. Prospective studies are needed to test whether these measurements may help predict optimal delivery sheath sizes for HBP and CS lead placement.

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