A curious case of impossible coronary sinus cannulation

Area of Science:

• Cardiology
• Embryology
• Medical Imaging

Background:

• A 40-year-old male presented with symptomatic Wolff-Parkinson-White (WPW) syndrome requiring radiofrequency ablation.
• Recurrent palpitations were the primary symptom necessitating intervention.

Purpose of the Study:

• To report a rare case of coronary sinus atresia with persistent left superior vena cava.
• To discuss the embryological basis of this anomaly.
• To highlight management challenges during electrophysiological studies.

Main Methods:

• Electrophysiological study with attempted radiofrequency ablation.
• Coronary venography to delineate venous anatomy.
• Review of embryological development of systemic venous return.

Main Results:

• Difficulty encountered during coronary sinus cannulation.
• Coronary venography confirmed coronary sinus atresia and a persistent left superior vena cava.
• Collateral venous pathways were identified draining into the right atrium.

Conclusions:

• Coronary sinus atresia with persistent left superior vena cava is a rare anomaly.
• This anomaly presents significant challenges during electrophysiological procedures.
• Understanding embryology is crucial for managing such complex cardiac cases.