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JACC. Cardiovascular Interventions Jul 2022The coronary sinus has become a popular route for an increasing number of innovative transcatheter interventions to treat coronary and structural heart diseases.... (Review)
Review
The coronary sinus has become a popular route for an increasing number of innovative transcatheter interventions to treat coronary and structural heart diseases. However, interventional cardiologists have limited experience with the cardiac venous system and its highly variable anatomy. In this paper, we review the anatomy of the cardiac veins as it relates to transcatheter interventions. We also provide a contemporary overview of the emerging coronary sinus-based transcatheter therapies and their growing literature.
Topics: Cardiac Catheterization; Coronary Sinus; Heart Valve Prosthesis Implantation; Humans; Mitral Valve; Mitral Valve Insufficiency; Treatment Outcome
PubMed: 35863788
DOI: 10.1016/j.jcin.2022.05.039 -
Journal of Cardiovascular... Nov 2022Intracardiac echocardiography (ICE) has become an essential tool and is an integral part of percutaneous interventional and electrophysiology (EP) procedures.... (Review)
Review
Intracardiac echocardiography (ICE) has become an essential tool and is an integral part of percutaneous interventional and electrophysiology (EP) procedures. Intracardiac echocardiography offers real-time, high-quality, near-field evaluation of cardiac anatomy. Standard ICE imaging includes placing the catheter in the right atrium (RA), right ventricle (RV), or left atrium (LA, via the transeptal approach). Coronary sinus echocardiography (CSE) is another alternative, where the ICE catheter is positioned in the coronary sinus (CS). This approach offers better catheter stability and allows operators to visualize cardiac structure with particularly excellent views of the LA, LAA, left ventricle (LV), and mitral annulus. Additionally, CSE is an attractive alternative in cases with unfavorable interatrial septum or fossa ovalis anatomical features that could lead to difficulty advancing ICE catheter in left atrium. In this article focusing on CSE, we provide illustration-based guidance to help operators identify critical cardiac structures from CSE.
Topics: Humans; Coronary Sinus; Ultrasonography, Interventional; Echocardiography; Heart Atria; Mitral Valve; Cardiac Catheterization
PubMed: 36153661
DOI: 10.1111/jce.15687 -
Journal of Cardiovascular Computed... 2020Coronary venous anatomy can be divided into the greater cardiac venous system and the lesser cardiac venous system. With protocol optimization, including appropriate... (Review)
Review
Coronary venous anatomy can be divided into the greater cardiac venous system and the lesser cardiac venous system. With protocol optimization, including appropriate contrast bolus timing, coronary veins can be depicted with excellent detail on CT. Knowledge of variant coronary venous anatomy can sometimes play a role in pre-procedural planning. Analysis of the coronary venous anatomy on CT can detect coronary venous anomalies that cause right to left shunts with risk of stroke, left to right shunts, and arrhythmias.
Topics: Computed Tomography Angiography; Coronary Angiography; Coronary Sinus; Coronary Vessel Anomalies; Coronary Vessels; Humans; Phlebography; Predictive Value of Tests
PubMed: 31444098
DOI: 10.1016/j.jcct.2019.08.006 -
The Journal of Innovations in Cardiac... Jun 2017The increasing number of cardiac resynchronization therapy devices implanted, coupled with the increasing incidence of cardiac implantable electronic device infection,... (Review)
Review
The increasing number of cardiac resynchronization therapy devices implanted, coupled with the increasing incidence of cardiac implantable electronic device infection, has led to a greater need for extraction of coronary venous pacing leads. The objectives of this study were to review the indications, techniques and published results of coronary venous lead extraction. In this study, we searched PubMed using the search terms "lead extraction," "coronary sinus," "coronary venous," "pacing," and "cardiac resynchronization therapy" for relevant papers. The reference lists of relevant articles were also searched, and personal experience was drawn upon. Published success rates and complications were found to be similar to those reported for non-coronary venous leads in experienced centers. However, reimplantation success differs and can be limited by vessel occlusion postextraction. The available active fixation coronary sinus lead (Attain Starfix™; Medtronic, MN, USA) is a particularly complex lead to extract, whereas limited data on the newer active fixation leads (Attain Stability™, Medtronic, MN, USA) suggest that they are less challenging to remove. The study concluded that coronary venous lead extraction presents unique challenges, especially reimplantation, that require special consideration and planning to overcome.
PubMed: 32494456
DOI: 10.19102/icrm.2017.080604 -
EuroIntervention : Journal of EuroPCR... Feb 2020Refractory angina is a growing problem, predominantly due to advanced coronary artery disease, associated with a reduced quality of life and an increased hospitalisation... (Review)
Review
Refractory angina is a growing problem, predominantly due to advanced coronary artery disease, associated with a reduced quality of life and an increased hospitalisation rate with a corresponding impact on healthcare resources. There is an unmet clinical need to be addressed by novel therapeutic approaches. Over the last few years, a treatment approach causing a controlled coronary sinus narrowing by implantation of a balloon-expandable, hourglass-shaped, stainless steel mesh (i.e., the coronary sinus Reducer) has arisen with promising initial short-term and midterm results, in terms of reducing angina and ischaemia burden and improving quality of life. Guidance with proper implantation algorithms and knowledge on how to address potential complications will improve interventional outcomes and foster a wider application of this novel therapeutic approach. In this review, we summarise the implantation technique, the causes of potential complications, and algorithms focusing upon their practical management, based on the experience of the authors.
Topics: Angina Pectoris; Coronary Artery Disease; Coronary Sinus; Heart; Humans; Quality of Life; Stents
PubMed: 30967360
DOI: 10.4244/EIJ-D-18-01180 -
Romanian Journal of Morphology and... 2019Unroofed coronary sinus (UCS) is among the rarest congenital heart malformations in pediatric practice. Often, they are associated with persistent left superior vena... (Review)
Review
Unroofed coronary sinus (UCS) is among the rarest congenital heart malformations in pediatric practice. Often, they are associated with persistent left superior vena cava (PLSVC) draining into the left atrium, and in this situation, there is a double intracardiac shunt, right-to-left and left-to-right. They are asymptomatic in the majority of the cases. Each ordinary imagistic method (transthoracic echocardiography, contrast transesophageal echocardiography, angiography) can be helpful in finding the diagnosis, but enhanced computed tomography scan can give an irrefutable diagnosis. The surgical intervention may consist in the recreation of a roof for the coronary sinus, and anastomosis of the PLSVC to the right atrial appendage.
Topics: Coronary Sinus; Female; Humans; Male
PubMed: 31263825
DOI: No ID Found -
The Journal of Invasive Cardiology Nov 2021Refractory angina affects an increasing proportion of the population with advanced coronary artery disease and microvascular dysfunction. Limited effective...
Refractory angina affects an increasing proportion of the population with advanced coronary artery disease and microvascular dysfunction. Limited effective pharmacological and interventional therapies exist for this patient cohort. The coronary sinus (CS) reducer, recently recommended in the 2019 guidelines of the European Society of Cardiology for the management of chronic refractory angina, is a balloon-expandable, stainless-steel device designed for implantation in the CS. It acts by increasing CS pressure, thereby redistributing blood to ischemic myocardium, relieving symptoms, and improving quality of life. However, between 15%-30% of patients do not respond to this treatment. Six mechanisms appear to explain this poor response to CS reducer therapy: (1) inappropriate patient selection; (2) cardiac venous system heterogeneity; (3) CS size; (4) incomplete device endothelialization; (5) coronary artery disease phenotype and progression; and (6) limited myocardial ischemia at baseline. We hereby review these mechanisms in detail and highlight key areas that should be addressed in order to try and reduce the burden of non-responders following CS reducer implantation.
Topics: Angina Pectoris; Coronary Artery Disease; Coronary Sinus; Humans; Quality of Life; Treatment Outcome
PubMed: 34544037
DOI: No ID Found -
European Heart Journal. Case Reports Dec 2020Unroofed coronary sinus (UCS) is a rare congenital cardiac anomaly in which there is complete or partial absence of the roof of the coronary sinus (CS) resulting in a...
BACKGROUND
Unroofed coronary sinus (UCS) is a rare congenital cardiac anomaly in which there is complete or partial absence of the roof of the coronary sinus (CS) resulting in a communication between the right and left atria. There are four types of UCS described in the literature. While usually asymptomatic and discovered incidentally on imaging, UCS can be the source of a brain abscess or paradoxical embolism.
CASE SUMMARY
A 62-year-old gentleman presented to the emergency department with sudden onset of right-sided weakness and subsequent unresponsiveness. His brain computed tomography (CT) was consistent with left-sided stroke. Transthoracic echocardiography was remarkable for a dilated CS and an agitated saline study was suggestive of an UCS. A gated cardiac CT with coronary angiography confirmed a wide communication between the CS and left atrium. Right heart catheterization did not show evidence of left to right shunt. He had no abnormal rhythm on telemetry monitoring throughout his hospital stay.
DISCUSSION
Unroofed coronary sinus is the least prevalent form of an atrial septal defect. Unroofed coronary sinus is usually asymptomatic and is diagnosed incidentally in imaging studies, however, it should be suspected in patients with cerebral emboli or evidence of left to right shunt with unexplained arterial desaturation. Transthoracic echocardiography is the most widely used imaging modality for the diagnosis of UCS but is limited in its ability to visualize the posterior cardiac structures such as the CS and pulmonary veins. Gated cardiac CT is a great diagnostic tool for UCS.
PubMed: 33629015
DOI: 10.1093/ehjcr/ytaa421