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

Circulation ◽  
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.

scholarly journals Coronary sinus atrial septal defects in adults over the past 20 years at new Tokyo hospital: case series

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Haruhiko Sugimori ◽  
Tatsuya Nakao ◽  
Yuki Ikegaya ◽  
Daisuke Iwahashi ◽  
Shoichi Tsuda ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Surgical Repair ◽  
Wide Spectrum ◽  
Superior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Right Atrial ◽  
Valvular Regurgitation ◽  
Type Iv ◽  
The Right

Abstract Background An isolated coronary sinus (CS) atrial septal defect (ASD) is defined as a CS unroofed in the terminal portion without a persistent left superior vena cava or other anomalies. This defect is rare and part of the wide spectrum of unroofed CS syndrome (URCS). Recently, several reports have described this finding. The database of New Tokyo Hospital was searched to determine the incidence of this defect. Additionally, to raise awareness of this condition, the findings from five patients with CS ASD who underwent surgical repair at New Tokyo Hospital are discussed. Case presentation The patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with different combinations and degrees of mitral, tricuspid, and aortic valve involvement. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. Conclusions CS ASD (Kirklin and Barratt–Boyes type IV URCS) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries at New Tokyo Hospital from 1999 to 2019. At New Tokyo Hospital, cardiac surgery is performed mainly for patients with acquired cardiac disease, and CS ASD is rare. Early diagnosis is important, as well as early surgical repair in symptomatic patients, especially those with blood access shunts, which may overload the heart. The case of a poor prognosis in this series is noteworthy, as similar cases have not been reported previously.

scholarly journals Coronary Sinus Atrial Septal Defects in Adults over the Past 20 Years at New Tokyo Hospital: Case Series

2021 ◽  
Author(s):  
Haruhiko Sugimori ◽  
Tatsuya Nakao ◽  
Yuki Ikegaya ◽  
Daisuke Iwahashi ◽  
Shoichi Tsuda ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Surgical Repair ◽  
Wide Spectrum ◽  
Superior Vena ◽  
Vena Cava ◽  
Case Series ◽  
Right Atrial ◽  
Valvular Regurgitation ◽  
Unroofed Coronary Sinus ◽  
Type Iv

Abstract Background: Isolated coronary sinus atrial septal defect (ASD) is defined as a coronary sinus unroofed in the terminal portion without a persistent left superior vena cava and other anomalies. This defect is rare and part of a wide spectrum of unroofed coronary sinus syndromes. Recently, several reports have described this finding. We searched the hospital’s database to determine the incidence of this defect, and to raise awareness of this condition, we discussed the findings from five patients with coronary sinus ASD who underwent surgical repair.Case presentation: The patients were three women and two men with an age range of 63–77 years. All patients underwent transthoracic echocardiography and computed tomography, and one underwent magnetic resonance imaging. In two patients, the defect was found unexpectedly intraoperatively; left-to-right shunting was apparent in the other three patients preoperatively. The pulmonary-to-systemic blood flow ratio ranged from 1.42 to 3.1 following cardiac catheterization, and oxygen saturation step-up was seen on the right side of the heart. Valvular regurgitation was seen in 4/5 patients with the mitral, tricuspid, and aortic valves involved in different combinations and to different degrees. Right atrial and ventricular dilation were seen in 4/5 patients; three patients had left atrial dilation. Three patients experienced atrial fibrillation, and one of these also experienced paroxysmal ventricular contractions. All patients underwent surgical repair, and some underwent multiple procedures. One patient who had previously undergone kidney transplantation died approximately 1 year postoperatively; the remaining four patients are currently experiencing good activities of daily living without symptoms. Conclusions: Coronary sinus ASD (Kirklin and Barratt–Boyes type IV unroofed coronary sinus syndrome) comprised 1.3% of adult congenital heart surgeries and 0.07% of adult open-heart surgeries in our hospital from 1999 to 2019. Our hospital performs cardiac surgery mainly for patients with acquired cardiac disease, and coronary sinus ASD is rare. Early diagnosis and, in symptomatic patients (especially those with blood access shunts, which may overload the heart), early surgical repair are important. The poorly prognostic case in our series is noteworthy, as similar cases have not been reported previously.

Atresia of the right atrial ostium of the coronary sinus without persistent left superior vena cava

2015 ◽  
Vol 9 (3) ◽  
pp. 227-229
Author(s):  
Nobuo Tomizawa ◽  
Masamichi Takahashi ◽  
Masakazu Kaneko ◽  
Kou Suzuki ◽  
Yujiro Matsuoka
Keyword(s):  
Superior Vena Cava ◽  
Coronary Sinus ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
The Right

scholarly journals Implantation of a Dual-Chamber Automatic Cardioverter Defibrillator in a Patient with Persistent Left Superior Vena Cava: Case Report and Brief Literature Review

Diagnostics ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 1071
Author(s):  
Mihai Cristian Haba ◽  
Andreea Maria Ursaru ◽  
Antoniu Octavian Petriș ◽  
Ștefan Eduard Popescu ◽  
Nicolae Dan Tesloianu
Keyword(s):  
Superior Vena Cava ◽  
Coronary Sinus ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Dual Chamber ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Cardioverter Defibrillator

Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3–0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF—27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible.

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