J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 2 2 7 e2 2 9
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Atresia of the right atrial ostium of the coronary sinus without persistent left superior vena cava Nobuo Tomizawa MD, PhDa,b,*, Masamichi Takahashi MDb, Masakazu Kaneko MDc, Kou Suzuki MD, PhDc, Yujiro Matsuoka MD, PhDb a
Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan Department of Radiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan c Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan b
article info
abstract
Article history:
We present a case of atresia of the right atrial ostium of the coronary sinus. Recognizing
Received 13 December 2014
this anomaly is important during catheter ablation or cardiac surgery, which could be
Accepted 16 December 2014
noninvasively evaluated by multidetector CT.
Available online 7 January 2015
ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved.
Keywords: Anomaly Coronary sinus Right atrial ostium
A 71-year-old man was scheduled for prostatectomy for prostate cancer treatment. During the operation, narrow QRS tachycardia appeared, which changed to atrial flutter after intravenous injection of adenosine triphosphate. Cardiac ablation therapy was planned after the surgery; thus, cardiac CT was scheduled. The CT findings showed an abnormally enlarged coronary sinus with atresia of the right atrial ostium (Figs. 1A, 2A). An anomalous vein arose from the coronary sinus running behind the left atrial appendage which ended at the left atrium (Figs. 1B, 2B). Other anomalies such as persistent left superior vena cava or atrial septal defect were not
found. A small vessel connected the coronary sinus and the right side of the right atrium (Fig. 2C). Ablation therapy was canceled after the cardiac CT because this anomaly might cause fatal complications during the therapy. Coronary sinus anomalies are rare and most cases are reported at autopsy.1 Notwithstanding lack of clinical symptoms, failure to recognize this anomaly could be troublesome during catheter ablation or cardiac surgery. Isolation of pulmonary veins as well as ablation targeted at the coronary sinus region is effective in curing atrial firbrillation.2 However, procedures involving the coronary sinus could cause
Conflict of interest: The authors report no conflicts of interest. * Corresponding author. E-mail address: [email protected] (N. Tomizawa). 1934-5925/$ e see front matter ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2014.12.005
228
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 2 2 7 e2 2 9
Fig. 1 e (A) Axial image of the CT at the level of the coronary sinus (CS). No communication was observed between the CS and the right atrium (RA). (B) Curved planar reformatted image of the anomalous vein connecting the CS and the left atrium (LA).
thrombosis of the coronary sinus which is often fatal.3 Retrograde coronary sinus cardioplegia perfusion is widely used as a method of myocardial protection during cardiac surgery requiring cardiopulmonary bypass,4 but it can not be performed in patients with coronary sinus atresia. Cardiac CT is a useful tool to assess the anatomic information of these anomalies.
Acknowledgments The authors thank doctors Yousuke Nishihara of the Department of Radiology and Toru Iwama of the Department of Cardiology of Bokutoh Hospital for their contributions in preparing this article.
Fig. 2 e (A) Caudal view of the volume-rendered image shows abnormally enlarged coronary sinus (CS) without communication to the right atrium (RA). (B) The left side shows an anomalous vein (asterisk) connecting the CS and the left atrium (LA). (C) The right side shows a small vessel (arrow) connecting the CS and the right side of the RA.
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 2 2 7 e2 2 9
references
1. Mantini E, Grondin CM, Lillehei CW, Edwards JE. Congenital anomalies involving the coronary sinus. Circulation. 1966;33:317e327. 2. Haı¨ssaguerre M, Hocini M, Takahashi Y, et al. Impact of catheter ablation of the coronary sinus on paroxysmal or
229
persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18:378e386. 3. Yeo KK, Davenport J, Raff G, Laird JR. Life-threatening coronary sinus thrombosis following catheter ablation: case report and review of literature. Cardiovasc Revasc Med. 2010;11:262.e1e262.e5. 4. Solorzano J, Taitelbaum G, Chiu RC. Retrograde coronary sinus perfusion for myocardial protection during cardiopulmonary bypass. Ann Thorac Surg. 1978;25:201e208.
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.JournalofCardiovascularCT.com
Images in Cardiovascular CT
Atresia of the right atrial ostium of the coronary sinus without persistent left superior vena cava Nobuo Tomizawa MD, PhDa,b,*, Masamichi Takahashi MDb, Masakazu Kaneko MDc, Kou Suzuki MD, PhDc, Yujiro Matsuoka MD, PhDb a
Department of Radiology, New Tokyo Hospital, 1271 Wanagaya, Matsudo, Chiba 270-2232, Japan Department of Radiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan c Department of Cardiology, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan b
article info
abstract
Article history:
We present a case of atresia of the right atrial ostium of the coronary sinus. Recognizing
Received 13 December 2014
this anomaly is important during catheter ablation or cardiac surgery, which could be
Accepted 16 December 2014
noninvasively evaluated by multidetector CT.
Available online 7 January 2015
ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved.
Keywords: Anomaly Coronary sinus Right atrial ostium
A 71-year-old man was scheduled for prostatectomy for prostate cancer treatment. During the operation, narrow QRS tachycardia appeared, which changed to atrial flutter after intravenous injection of adenosine triphosphate. Cardiac ablation therapy was planned after the surgery; thus, cardiac CT was scheduled. The CT findings showed an abnormally enlarged coronary sinus with atresia of the right atrial ostium (Figs. 1A, 2A). An anomalous vein arose from the coronary sinus running behind the left atrial appendage which ended at the left atrium (Figs. 1B, 2B). Other anomalies such as persistent left superior vena cava or atrial septal defect were not
found. A small vessel connected the coronary sinus and the right side of the right atrium (Fig. 2C). Ablation therapy was canceled after the cardiac CT because this anomaly might cause fatal complications during the therapy. Coronary sinus anomalies are rare and most cases are reported at autopsy.1 Notwithstanding lack of clinical symptoms, failure to recognize this anomaly could be troublesome during catheter ablation or cardiac surgery. Isolation of pulmonary veins as well as ablation targeted at the coronary sinus region is effective in curing atrial firbrillation.2 However, procedures involving the coronary sinus could cause
Conflict of interest: The authors report no conflicts of interest. * Corresponding author. E-mail address: [email protected] (N. Tomizawa). 1934-5925/$ e see front matter ª 2015 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2014.12.005
228
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 2 2 7 e2 2 9
Fig. 1 e (A) Axial image of the CT at the level of the coronary sinus (CS). No communication was observed between the CS and the right atrium (RA). (B) Curved planar reformatted image of the anomalous vein connecting the CS and the left atrium (LA).
thrombosis of the coronary sinus which is often fatal.3 Retrograde coronary sinus cardioplegia perfusion is widely used as a method of myocardial protection during cardiac surgery requiring cardiopulmonary bypass,4 but it can not be performed in patients with coronary sinus atresia. Cardiac CT is a useful tool to assess the anatomic information of these anomalies.
Acknowledgments The authors thank doctors Yousuke Nishihara of the Department of Radiology and Toru Iwama of the Department of Cardiology of Bokutoh Hospital for their contributions in preparing this article.
Fig. 2 e (A) Caudal view of the volume-rendered image shows abnormally enlarged coronary sinus (CS) without communication to the right atrium (RA). (B) The left side shows an anomalous vein (asterisk) connecting the CS and the left atrium (LA). (C) The right side shows a small vessel (arrow) connecting the CS and the right side of the RA.
J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 9 ( 2 0 1 5 ) 2 2 7 e2 2 9
references
1. Mantini E, Grondin CM, Lillehei CW, Edwards JE. Congenital anomalies involving the coronary sinus. Circulation. 1966;33:317e327. 2. Haı¨ssaguerre M, Hocini M, Takahashi Y, et al. Impact of catheter ablation of the coronary sinus on paroxysmal or
229
persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18:378e386. 3. Yeo KK, Davenport J, Raff G, Laird JR. Life-threatening coronary sinus thrombosis following catheter ablation: case report and review of literature. Cardiovasc Revasc Med. 2010;11:262.e1e262.e5. 4. Solorzano J, Taitelbaum G, Chiu RC. Retrograde coronary sinus perfusion for myocardial protection during cardiopulmonary bypass. Ann Thorac Surg. 1978;25:201e208.
