Surgical approach to left ventricular inflow obstruction due to dilated coronary sinus

Area of Science:

• Cardiovascular Surgery
• Congenital Heart Defects
• Anatomical Malformations

Background:

• A rare congenital anomaly involves the left superior vena cava (LSVC) draining into the coronary sinus (CS), potentially causing left ventricular inflow obstruction.
• This malformation can lead to severe hemodynamic compromise, particularly in critically ill patients.

Purpose of the Study:

• To report the surgical outcomes of four severely ill patients with LSVC draining to a dilated CS.
• To describe an original surgical approach for repairing this complex congenital heart defect.

Main Methods:

• A novel surgical procedure was developed, involving complete resection of the CS wall within the left atrium.
• The LSVC was divided, and continuity was re-established between the LSVC and the right atrium via an anastomosis with the right atrial appendage.
• One patient with interrupted inferior vena cava and hemiazygous continuation to the LSVC was included.

Main Results:

• The surgical repair demonstrated no operative mortality.
• All patients showed the absence of residual left ventricular inflow obstruction post-operatively.
• Follow-up confirmed an unobstructed connection from the LSVC to the right atrial appendage and right atrium.

Conclusions:

• The described surgical technique effectively relieved left ventricular inflow obstruction in patients with LSVC draining to a dilated CS.
• The repair successfully preserved adequate systemic venous return, offering a predictable solution for this malformation.