Coronary Sinus Blues - A Word Of Caution When Placing The Coronary Sinus In The Left Atrium
Mohan John, Paul Chai.
Children's Healthcare of Atlanta/ Emory University, Atlanta, GA, USA.
Objective: We present a challenging case of inadvertent placement of the coronary sinus (CS) in the left ventricle (LV) during left atrio-ventricular (AV) valve replacement, and the complications that resulted therein.
Methods: A review the patient's electronic medical record was performed.
Results: A term neonate underwent repair of transitional AV canal defect and coarctation of the aorta, during which the CS was placed in the left atrium (LA). She developed progressive left AV valve regurgitation requiring valve replacement at 8 months. Gradients across the prosthetic valve remained stable till 10 years of age, when they increased to 22 mm Hg. Cardiac computed tomography (CT) showed a distended CS emptying unexpectedly into the LV. Redo left AV valve replacement was performed with a 27mm prosthesis, ensuring CS placement in the LA. The patient presented 1 month later with deterioration of LV function. On evaluation, she was found to have obstruction to the CS ostium. She was taken to the operating room and the prosthetic valve explanted. Pannus seen around the sewing ring was excised. The CS ostium was located and opened widely. A 25mm prosthesis was implanted, and the CS placed back in the right atrium (RA). Ventricular function improved initially, but follow up CT 1 month later showed recurrent CS obstruction. LV function remained moderately depressed and oral heart failure therapy was initiated. The team consensus was to manage the patient non-operatively.
Conclusions: Complications related to the CS are rare and difficult to diagnose without a high index of suspicion.
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