Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 127; no. 4; pp. 959 - 962
• Main Authors: DiBardino, Daniel J, Fraser, Charles D., Jr, Dickerson, Heather A, Heinle, Jeffrey S, McKenzie, E. Dean, Kung, Grace
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA AATS/WTSA 01.04.2004; Elsevier
• Subjects: Adolescent; Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Cardiac Surgical Procedures; Cardiology. Vascular system; Child; Child, Preschool; Coronary Vessel Anomalies - complications; Coronary Vessel Anomalies - diagnostic imaging; Coronary Vessel Anomalies - therapy; Dilatation, Pathologic - complications; Dilatation, Pathologic - diagnostic imaging; Dilatation, Pathologic - therapy; Echocardiography; Female; Follow-Up Studies; Heart Arrest, Induced; Heart Ventricles - abnormalities; Heart Ventricles - diagnostic imaging; Heart Ventricles - surgery; Humans; Hypothermia, Induced; Infant; Male; Medical sciences; Mitral Valve - abnormalities; Mitral Valve - diagnostic imaging; Mitral Valve - surgery; Pneumology; Postoperative Care; Preoperative Care; Statistics as Topic; Treatment Outcome; Vena Cava, Superior - abnormalities; Vena Cava, Superior - diagnostic imaging; Vena Cava, Superior - surgery; Ventricular Outflow Obstruction - complications; Ventricular Outflow Obstruction - diagnostic imaging; Ventricular Outflow Obstruction - therapy; Ventricular Pressure - physiology; Association; Persistent left superior vena cava; Anesthesia; Circulatory system; Cardiology; Obstruction; Left ventricle; Coronary sinus
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2003.07.010

It has previously been suggested that significant dilatation of the coronary sinus can contribute to left ventricular inflow obstruction and is amenable to surgical correction. The purpose of this study was to review our experience with this rare condition. Since 1995, 6 patients have undergone coronary sinus reduction for concerns of obstruction with other concomitant intracardiac repairs. Preoperative echocardiography identified a significantly dilated left superior vena cava to the coronary sinus in 5 patients (83%) and an abnormal mitral valve in 4 patients (67%); these resulted in abnormal Doppler inflow patterns. Preoperative cardiac catheterization was performed in 5 patients and revealed increased atrial "a" waves, with a gradient to the left ventricular end-diastolic pressure in each case. At the time of surgery, coronary sinus angioplasty was performed in all patients. There were no deaths, and there was no major morbidity. Follow-up imaging revealed no significant left ventricular inflow obstruction in any patient. We conclude that dilatation of the coronary sinus can become hemodynamically significant and that coronary sinus angioplasty is a safe and effective technique.