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6. The combination of coronary sinus ostial atresia/abnormalities and a small persistent left superior vena cava—Opportunity for left ventricular lead implantation and unrecognized source of thromboembolic stroke

Author

Susan O’Donoghue, Athanasios Thomaides, Matthew Sellers, Torkel Steen, David Strouse, Khalil Kanjwal, Alexander Kushnir, Santosh K. Padala, Seth J. Worley, Michael J. Kaufman, Devi Nair, Matthew McKillop, Cyrus A. Hadadi, Sahar Mouram, Fengwei Zou, and Basar Candemir

Subjects
Adult, Male, Pacemaker, Artificial, medicine.medical_specialty, Ventricular lead, Venography, Thromboembolic stroke, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Persistent Left Superior Vena Cava, Physiology (medical), Internal medicine, medicine, Humans, Abnormalities, Multiple, 030212 general & internal medicine, Persistent left superior vena cava, Stroke, Coronary sinus, Aged, Retrospective Studies, medicine.diagnostic_test, business.industry, Coronary Sinus, Middle Aged, medicine.disease, Intracranial Embolism, Atresia, Cardiology, Female, Radiography, Thoracic, Implant, Cardiology and Cardiovascular Medicine, business
Abstract

Background Coronary sinus (CS) ostial atresia/abnormalities prevent access to the CS from the right atrium (RA) for left ventricular (LV) lead implantation. Some patients with CS ostial abnormalities also have a small persistent left superior vena cava (sPLSVC). Objective The purpose of this study was to describe CS ostial abnormalities and sPLSVC as an opportunity for LV lead implantation and unrecognized source of stroke. Methods Twenty patients with CS ostial abnormalities and sPLSVC were identified. Clinical information, imaging methods, LV lead implantation techniques, and complications were summarized. Results Forty percent had at least 1 previously unsuccessful LV lead placement. In 70%, sPLSVC was identified by catheter manipulation and contrast injection in the left brachiocephalic vein, and in 30% by levophase CS venography. In 30%, sPLSVC was associated with drainage from the CS into the left atrium (LA). When associated with CS ostial abnormalities, the sPLSVC diameter averaged 5.6 ± 3 mm. sPLSVC was used for successful LV lead implantation in 90% of cases. In 80%, the LV lead was implanted down sPLSVC, and in 20%, sPLSVC was used to access the CS from the RA. Presumably because of unrecognized drainage from the CS to the LA, 1 patient had a stroke during implantation via sPLSVC. Conclusion When CS ostial abnormalities prevent access to the CS from the RA, sPLSVC can be used to successfully implant LV leads. In some, the CS partially drains into the LA and stroke can occur spontaneously or during lead intervention. It is important to distinguish sPLSVC associated with CS ostial abnormalities from isolated PLSVC.

Published
2021
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