Surgical Creation of the Coronary Sinus Orifice in an Octogenarian With Heart Failure
Yuichi Yoshida1, Shinya Yokoyama2, Kozo Kaneda2
1Department of Cardiovascular Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Insights
Coronary sinus ostial atresia, a rare condition, was successfully treated in an 82-year-old man with right-sided heart failure. Surgical reconstruction of the coronary sinus provided significant cardiovascular benefits, demonstrating feasibility in elderly patients.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Anatomy
Background:
- Coronary sinus (CS) ostial atresia is a rare congenital anomaly, frequently associated with persistent left superior vena cava (PLSVC).
- Its occurrence in the elderly population is exceptionally rare, presenting unique clinical challenges.
- Right-sided heart failure can be a consequence of severe CS obstruction.
Abstract:
Coronary sinus (CS) ostial atresia is rare, often coexisting with a persistent left superior vena cava (PLSVC), and is exceptional in elderly patients. Right-sided heart failure developed in an 82-year-old man 2 years after aortic valve replacement. Computed tomography and cardiac magnetic resonance imaging showed CS ostial closure and long-segment stenosis at the PLSVC-left brachiocephalic vein junction. At reoperation, a CS neo-ostium was created, followed by ligation of the PLSVC and tricuspid valve replacement. Postoperative imaging showed direct CS drainage into the right atrium, improved coronary venous washout, and reduced left ventricular dimension. Physiologic coronary venous reconstruction may benefit selected octogenarians with CS ostial atresia.
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