Coronary Sinus Lead Placement in Patients With Coronary Sinus Ostial Atresia

Figures

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  Figure 1. (A) Venous phase of coronary angiography demonstrated coronary sinus (CS) with no contrast entering the right atrium and draining superiorly. A decapolar CS catheter, inserted from the right femoral vein, is near the expected location of the CS ostium. (B) Contrast injection of persistent left superior vena cava, oblique vein of left atrium (arrow), and CS. (C) Subselect catheter positioned in the CS with a guidewire advanced to the middle cardiac vein but no connection to the right atrium. (D) The subselect catheter is prolapsed in the CS with a guidewire in the posterolateral target vessel. (E) A subselect catheter with an inner dilator is advanced to the posterolateral target vessel, which is visualized with contrast injection. (F) Final position of quadripolar CS lead in the target vessel.

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  Figure 2. Case 1: Computed Tomography Scan, Venogram, Chest X-Ray, and Anatomical Illustration (A) Computed tomography scan showing persistent left superior vena cava connection from left brachiocephalic (arrow). (B) Contrast injection of persistent left superior vena cava demonstrating connection to oblique vein of left atrium and then coronary sinus (CS). (C) CS lead final position on chest radiograph. (D) Computed tomography scan showing oblique vein of left atrium connection to CS with a blind ended pouch without right atrial connection. (E) An anatomic drawing indicating a CS with a blind ended pouch without connection to the right atrium with venous drainage via the oblique vein of the left atrium and persistent left superior vena cava.

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  Figure 3. Electrocardiogram A 12-lead electrocardiogram demonstrating biventricular pacing.

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  Figure 4. Case 2: Venogram and Chest X-Ray (A) Venogram showing coronary sinus draining into persistent left superior vena cava without connection to the right atrium. (B) Final lead position.