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A rare case of hypoplastic coronary sinus partially draining into right superior vena cava: A case report
Vivek Kumar1, Viveka Kumar1, Vanita Arora1
1Max Super Speciality Hospital, New Delhi, India.
Insights
This study reports the first case of hypoplastic coronary sinus (CS) tributaries draining into the right superior vena cava (SVC). This rare anomaly can pose challenges for cardiac resynchronization therapy (CRT) device implantation.
Area of Science:
- Cardiovascular Anatomy
- Cardiac Electrophysiology
- Congenital Heart Anomalies
Background:
- The coronary sinus (CS) is a critical component of the cardiac venous system.
- Hypoplastic CS, a rare anomaly, involves incomplete development of the CS.
- Tributaries typically drain into the CS or, less commonly, the right atrium via thebesian channels.
Observation:
- A patient with ischemic cardiomyopathy and severe left ventricular (LV) systolic dysfunction presented for cardiac resynchronization therapy with defibrillator (CRTD) implantation.
- Coronary sinus venography revealed a hypoplastic CS.
- A unique finding was the drainage of CS tributaries into the right superior vena cava (SVC).
Findings:
- The distal portion of the hypoplastic CS formed a common channel draining into the right SVC.
- Despite the anomaly, the posterolateral vein was adequately sized for LV lead placement.
- The CRTD procedure was successfully completed.
Implications:
- While hypoplastic CS is often asymptomatic, it presents a significant limitation for cardiac resynchronization therapy (CRT).
- Drainage of CS tributaries into the SVC is an extremely rare finding, possibly representing a persistent embryonic veno-cardinal vein.
- Understanding such venous anomalies is crucial for successful device implantation and patient management in electrophysiology.
Background:
The hypoplastic coronary sinus (CS) is a rare anomaly of the cardiac venous system, wherein some of the tributaries fail to join the CS. These tributaries usually drain into atrial chambers through dilated thebesian channels. We report the first case where the tributaries are draining into the right superior vena cava (SVC).
Case Summary:
A case of ischemic cardiomyopathy with severe LV systolic dysfunction with NYHA class III symptoms was taken for CRTD implantation. CS venogram after direct cannulation from left subclavian access revealed a hypoplastic CS. The part of CS beyond the attachment of the oblique vein of the left atrium to CS (distal to the posterolateral vein) formed a common channel and was draining into the right-sided SVC. The posterolateral vein was of sufficient caliber so that an left ventricle (LV) lead could be implanted, and the CRTD procedure could be completed.
Discussion:
Hypoplastic CS though has no pathological significance in the normal population but for CRT it can become a significant limitation. Tributaries of CS draining into right SVC are the rarest of the finding, the channel draining most likely is a remnant of the splanchnic plexus around the embryonic foregut that usually has a temporary communication with cardinal veins during intrauterine growth. This communication somehow has persisted and resulted in a channel between coronary vein and the SVC, which may be referred to as coronary veno-cardinal vein.
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