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Left Ventricular Lead Implantation for Cardiac Resynchronization Therapy
Published in Andrea Natale, Oussama M. Wazni, Kalyanam Shivkumar, Francis E. Marchlinski, Handbook of Cardiac Electrophysiology, 2020
Kushwin Rajamani, Michael P. Brunner, Oussama M. Wazni, Bruce L. Wilkoff
Even if electrogram guidance is initially attempted, when difficulty persists after performing this maneuver, “puffing” contrast dye through the sheath or catheter is frequently revealing. It may show the atrial sulcus, in which case the approach should be more posterior and superior. Contrast may also reveal either an early or separate take-off of a middle cardiac vein that is preferentially cannulated by the system. Slight manipulation of the system while using contrast may allow the main CS lumen to be selected. Other possibilities include an acutely angled ostium, vertical or tortuous initial segments, or narrowing in the CS from a mid-CS valve or stenosis resulting from prior surgery. In these situations, contrast is invaluable to determine the cause of difficulty and aid in determining the optimal remedy. In cases such as these, an inner guide-wire or diagnostic electrophysiology catheter may facilitate manipulation and provide support to allow passage of the outer sheath.
Fundamentals of cardiac electrophysiology
Published in Ever D. Grech, Practical Interventional Cardiology, 2017
Sunil Kapur, William G Stevenson, Roy M John
The coronary sinus extends from the inferior right atrial (RA) septum along the inferior mitral annulus. It has a muscular coat in its proximal course and transitions to the great cardiac vein that continues laterally and superiorly that is marked on the endovascular surface by the valve of Vieussen.6 The great cardiac vein lies alongside the left circumflex artery and continues to become the anterior interventricular vein that runs parallel to the left anterior descending coronary artery. Lateral left ventricular (LV) branches join the coronary sinus at various levels and are potential targets for placement of pacing leads for LV epicardial pacing. The middle cardiac vein is a proximal branch of the coronary sinus that runs in the posterior interventricular grove, parallel to the posterior descending coronary artery. Ablation of some posterior septal accessory pathways is possible from within this branch but runs the risk of inadvertent thermal damage to adjacent branches of the right coronary artery.
Coronary Circulation
Published in Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod, The Primary FRCA Structured Oral Examination Study Guide 1, 2017
Lara Wijayasiri, Kate McCombe, Paul Hatton, David Bogod
Describe the coronary circulation. The arterial blood supply to the heart comes from the right coronary artery (RCA) and the left coronary artery (LCA), which arise from the anterior and posterior aortic sinuses respectively.The RCA supplies the right atrium, right ventricle, sinoatrial node and, in 90% of people, also the atrioventricular node.The LCA divides into the left anterior descending (LAD) artery and the left circumflex (LCx) artery and supplies the left atrium, left ventricle and most of the interventricular septum.In 30% of the population the LCA and RCA supply equal proportions of blood while in 50% the RCA is the dominant vessel.Venous drainage occurs predominantly via the coronary sinus. This receives blood from the great cardiac vein (draining the anterior aspect of the heart) and the middle cardiac vein (draining the posterior aspect of the heart). In addition, there are other vessels that drain directly into the heart chambers including the thebesian veins, which contribute towards true shunt.
Coronary Sinus Defect, Premature Restriction of Foramen Ovale and Cysto-Colic Peritoneal Band
Published in Fetal and Pediatric Pathology, 2023
The coronary sinus is the most constant feature of the cardiac venous system [16–18], and of all of the branches of the coronary venous system, the great cardiac and middle cardiac vein [19] and posterior cardiac veins are the ones present most consistently [17]. Many of the these major cardiac veins anastomose and two rather constant venous anastomotic rings have been described [17]. The larger and more constant anastomotic ring (90%) connects the ends of the middle and great cardiac veins and the less constant (70%) ring connects the ends of the posterior and left marginal veins with a branch of the middle cardiac vein [17]. All the major veins also receive inconstant albeit innumerable, smaller branches, which contribute to an anastomotic network of veins in the epicardium [17]. Without the persistent left superior vena cava and left hypoplastic heart and in the absence of coronary sinus, it is tempting to speculate that the direct drainage of the major cardiac veins and their anastomotic channels into the left heart may have contributed to hemodynamic forces potentiating the closure of the foreman ovale (Fig. 2).
Coronary sinus ostial atresia with persistent left superior vena cava on cardiac computed tomography
Published in Acta Cardiologica, 2021
Shu Yoshihara, Taku Yaegashi, Masaki Matsunaga, Masaaki Naito
A 61-year-old man who had a history of hypertrophic cardiomyopathy with atrial tachyarrhythmia was referred for cardiac computed tomography (CCT) before scheduled electrophysiology studies. CCT showed coronary sinus (CS) atresia of the right atrial ostium in the crux cordis area which communicated with a persistent left superior vena cava (PLSVC; Figure 1(A,B,E)). The right SVC drained normally into the right atrium (RA; Figure 2(A,B)). In addition, two aberrant veins were found. First, tortuous vessels of 3 mm in diameter arose from the CS at separate points, then joined together and terminated into the left atrium (LA) (Figure 1(A,C,E) arrowheads). Second, a vessel of 2 mm in diameter arose from the middle cardiac vein (MCV), coursed in the right atrioventricular groove along the right coronary artery, and terminated into the inferior side of the RA (Figure 1(D,E) arrows). Atresia of the CS ostium with a PLSVC was diagnosed. Other congenital cardiac anomalies were not found.
Retrograde venography and three-dimensional mapping of a great cardiac vein with separate drainage into the high right atrium in a patient with Wolf-Parkinson-White syndrome
Published in Baylor University Medical Center Proceedings, 2018
Keith Suarez, Javier E. Banchs, Judith P. Lazol, James N. Black
Abnormalities in drainage of the GCV are not often heard of and are likely to be underreported, with most cases found incidentally in cardiac imaging and autopsy studies.1 This vein normally originates at the apex of the heart as the anterior interventricular vein and becomes the GCV as it reaches the lower to middle third of the interventricular sulcus.2 It then becomes the CS at the level of the Vieussens valve.2 This vein and the middle cardiac vein appear to be morphologically the most consistent of the coronary venous anatomy.2