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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 -
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 -
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 -
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 -
Journal of Cardiovascular... Oct 2022Markers predicting atrial fibrillation (AF) termination and freedom from AF/atrial tachycardia (AT) has been proposed. This study aimed to evaluate the role of novel...
INTRODUCTION
Markers predicting atrial fibrillation (AF) termination and freedom from AF/atrial tachycardia (AT) has been proposed. This study aimed to evaluate the role of novel coronary sinus (CS) electrogram characteristics in predicting the acute ablation response and freedom from AF/AT during follow-up.
METHODS
Patients undergoing ablation for persistent AF as part of the Stochastic Trajectory Analysis of Ranked signals mapping study were included. Novel CS electrogram characteristics including CS cycle length variability (CLV) and CS activation pattern stability (APS) and proportion of low voltage zones (LVZs) were reviewed as potential predictors for AF termination on ablation and freedom from AF/AT during follow-up. The relationship between localized driver characteristics and CS electrogram characteristics was also assessed.
RESULTS
Sixty-five patients were included. AF termination was achieved in 51 patients and 80% of patients were free from AF/AT during a follow-up of 29.5 ± 3.7 months. CS CLV of <30 ms, CS APS of ≥30% and proportion of LVZ < 30% showed high diagnostic accuracy in predicting AF termination on ablation and freedom from AF/AT during follow-up (CS CLV odds ratio [OR] 25.6, area under the curve [AUC] 0.91; CS APS OR 15.9, AUC 0.94; proportion of LVZs OR 21.4, AUC 0.88). These markers were independent predictors of AF termination on ablation and AF/AT recurrence during follow-up. Ablation of a smaller number of drivers that demonstrate greater dominance strongly correlate with greater CS organization.
CONCLUSION
Novel CS electrogram characteristics were independent predictors of AF termination and AF/AT recurrence during follow-up. These markers can potentially aid in predicting outcomes and guide ablation and follow-up strategies.
Topics: Atrial Fibrillation; Catheter Ablation; Coronary Sinus; Humans; Pulmonary Veins; Recurrence; Tachycardia, Supraventricular; Treatment Outcome
PubMed: 35775822
DOI: 10.1111/jce.15618 -
Herzschrittmachertherapie &... Jun 2022Knowledge of the coronary sinus (CS) anatomy is crucial for implantation of cardiac resynchronization therapy (CRT). Obstacles to CS entry, such as the Eustachian ridge... (Review)
Review
Knowledge of the coronary sinus (CS) anatomy is crucial for implantation of cardiac resynchronization therapy (CRT). Obstacles to CS entry, such as the Eustachian ridge and Thebesian valve, as well as within the CS, such as Vieussen's valve and the vein of Marshall, are important to understand and differentiate during implantation or to identify earlier by imaging. Anatomic knowledge is mandatory to select the most suitable side branch for lead implantation. Modern tools and techniques almost always enable other anatomic problems, such as tortuous, small, short, or overly straight side branches, to also be overcome.
Topics: Cardiac Resynchronization Therapy; Cardiac Resynchronization Therapy Devices; Coronary Sinus; Heart Failure; Humans
PubMed: 35648250
DOI: 10.1007/s00399-022-00863-x -
Brazilian Journal of Cardiovascular... Oct 2022Coronary artery fistula draining into the coronary sinus is a rare vascular malformation, and its diagnosis and clinical manifestations usually occur late. We describe...
Coronary artery fistula draining into the coronary sinus is a rare vascular malformation, and its diagnosis and clinical manifestations usually occur late. We describe the case of a 72-year-old female patient with dyspnea on exertion (New York Heart Association Class III) associated with palpitations. The transthoracic echocardiogram showed significant tricuspid insufficiency. Cardiac catheterization showed aneurysm of the circumflex coronary artery and fistula of this artery draining into the coronary sinus. The patient underwent fistula ligation and tricuspid valve repair, with excellent surgical results.
Topics: Female; Humans; Aged; Coronary Sinus; Coronary Vessel Anomalies; Coronary Angiography; Fistula; Coronary Artery Disease
PubMed: 35436077
DOI: 10.21470/1678-9741-2021-0254 -
Cardiovascular Revascularization... Mar 2020This study aims at evaluating the impact of BASILICA on neo-sinus and sinus hemodynamics with and without coronary flow. Leaflet thrombosis after valve-in-valve (ViV)...
BACKGROUND/PURPOSE
This study aims at evaluating the impact of BASILICA on neo-sinus and sinus hemodynamics with and without coronary flow. Leaflet thrombosis after valve-in-valve (ViV) may compromise not only leaflet mobility but also affect valve durability and performance.
METHODS/MATERIALS
In a 23 mm transparent surgical aortic valve model, a 23 mm Edwards SAPIEN 3 and a 26 mm Medtronic Evolut were deployed before and after leaflet laceration, in models with and without coronary flow. Neo-sinus and sinus hemodynamics were evaluated in the aortic position of a pulse duplicator and particle image velocimetry was performed in order to quantify sinus flow hemodynamics along with sinus and neo-sinus washout.
RESULTS
BASILICA-type leaflet laceration procedure led to (a) an increase in the velocities in the sinus and the neo-sinus by 50% for Evolut ViV with and without coronary flow, 70% for non-coronary SAPIEN 3 ViV and 10% for coronary SAPIEN 3 ViV, and (b) an improvement in overall washout up to 2 cycles in the neo-sinus and 0.5 cycles in the sinus.
CONCLUSIONS
A BASILICA-type leaflet laceration approach may improve sinus and neo-sinus hemodynamics through decreasing flow stasis and enabling less confined blood flow. BASILICA confers coronary sinus flow patterns to the non-coronary sinus.
Topics: Aortic Valve; Blood Flow Velocity; Coronary Circulation; Coronary Sinus; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Hemodynamics; Humans; Materials Testing; Prosthesis Design; Time Factors
PubMed: 31281093
DOI: 10.1016/j.carrev.2019.06.015