Successful Percutaneous Cardiac Resynchronization Despite an Occlusive Thebesian Valve

Overview

Journal Pediatr Cardiol

Specialties Cardiology & Vascular Diseases
Pediatrics

Date 2011 Aug 2

PMID 21805325

Citations 3

Authors

Milind G Parikh

Sean M Halleran

Saroja Bharati

Richard G Trohman

Affiliations

Soon will be listed here.

Abstract

We report the case of a patient with symptomatic heart failure referred after an unsuccessful attempt at cardiac resynchronization therapy. An occlusive Thebesian valve prevented entry into the coronary sinus ostium. Careful analysis of the patient's cardiovascular physiology and anatomy revealed the "fortuitous" presence of a persistent left superior vena cava. Cannulation of this vessel permitted percutaneous retrograde placement of a left ventricular lead into a posterolateral cardiac venous branch resulting in successful cardiac resynchronization. This unique case provides strong evidence that thorough knowledge of cardiac embryology, anatomy, and physiology plays a pivotal role in percutaneous electromechanical intervention for drug-refractory heart failure.

Citing Articles

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Anatomical barriers in the right atrium to the coronary sinus cannulation.

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Coronary venous system in cardiac computer tomography: Visualization, classification and role.

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References

Nsah E, Moore G, Hutchins G . Pathogenesis of persistent left superior vena cava with a coronary sinus connection. Pediatr Pathol. 1991; 11(2):261-9. DOI: 10.3109/15513819109064763. View

Abdulla R, Blew G, Holterman M . Cardiovascular embryology. Pediatr Cardiol. 2004; 25(3):191-200. DOI: 10.1007/s00246-003-0585-1. View

Cha E, KHOURY G . Persistent left superior vena cava. Radiologic and clinical significance. Radiology. 1972; 103(2):375-81. DOI: 10.1148/103.2.375. View

Birnie D, Tang A . Permanent pacing from a left ventricular vein in a patient with persistent left and absent right superior vena cava. Pacing Clin Electrophysiol. 2001; 23(12):2135-7. DOI: 10.1111/j.1540-8159.2000.tb00790.x. View

Oginosawa Y, Abe H, Nakashima Y . Prevalence of venous anatomic variants and occlusion among patients undergoing implantation of transvenous leads. Pacing Clin Electrophysiol. 2005; 28(5):425-8. DOI: 10.1111/j.1540-8159.2005.09534.x. View

Jongbloed M, Lamb H, Bax J, Schuijf J, de Roos A, van der Wall E . Noninvasive visualization of the cardiac venous system using multislice computed tomography. J Am Coll Cardiol. 2005; 45(5):749-53. DOI: 10.1016/j.jacc.2004.11.035. View

Smelley M, Shah D, Weisberg I, Kim S, Lin A, Beshai J . Initial experience using a radiofrequency powered transseptal needle. J Cardiovasc Electrophysiol. 2009; 21(4):423-7. DOI: 10.1111/j.1540-8167.2009.01656.x. View

Goyal S, Rosenthal L . Persistent left superior vena cava-inferior vena caval communication complicating implantation of an implantable cardioverter defibrillator. Pacing Clin Electrophysiol. 2005; 28(11):1245-6. DOI: 10.1111/j.1540-8159.2005.50184.x. View

Cleland J, Daubert J, Erdmann E, Freemantle N, Gras D, Kappenberger L . The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352(15):1539-49. DOI: 10.1056/NEJMoa050496. View

10.

Buirski G, Jordan S, JOFFE H, Wilde P . Superior vena caval abnormalities: their occurrence rate, associated cardiac abnormalities and angiographic classification in a paediatric population with congenital heart disease. Clin Radiol. 1986; 37(2):131-8. DOI: 10.1016/s0009-9260(86)80382-8. View

11.

Karaca M, Bilge O, Dinckal M, Ucerler H . The anatomic barriers in the coronary sinus: implications for clinical procedures. J Interv Card Electrophysiol. 2005; 14(2):89-94. DOI: 10.1007/s10840-005-4596-0. View

12.

van Gelder B, Elders J, Bracke F, Meijer A . Implantation of a biventricular pacing system in a patient with a coronary sinus not communicating with the right atrium. Pacing Clin Electrophysiol. 2003; 26(5):1294-6. DOI: 10.1046/j.1460-9592.2003.t01-1-00184.x. View

13.

Leclercq C, Kass D . Retiming the failing heart: principles and current clinical status of cardiac resynchronization. J Am Coll Cardiol. 2002; 39(2):194-201. DOI: 10.1016/s0735-1097(01)01747-8. View

14.

Hunt S . ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001.... J Am Coll Cardiol. 2005; 46(6):e1-82. DOI: 10.1016/j.jacc.2005.08.022. View

15.

Nelson G, Berger R, Fetics B, Talbot M, Spinelli J, Hare J . Left ventricular or biventricular pacing improves cardiac function at diminished energy cost in patients with dilated cardiomyopathy and left bundle-branch block. Circulation. 2000; 102(25):3053-9. DOI: 10.1161/01.cir.102.25.3053. View

16.

Paulussen G, van Gelder B . Implantation of a biventricular pacing system in a patient with a persistent left superior vena cava. Pacing Clin Electrophysiol. 2004; 27(7):1014-6. DOI: 10.1111/j.1540-8159.2004.00577.x. View

17.

Tang A, Wells G, Talajic M, Arnold M, Sheldon R, Connolly S . Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010; 363(25):2385-95. DOI: 10.1056/NEJMoa1009540. View

18.

Worley S . How to use balloons as anchors to facilitate cannulation of the coronary sinus left ventricular lead placement and to regain lost coronary sinus or target vein access. Heart Rhythm. 2009; 6(8):1242-6. DOI: 10.1016/j.hrthm.2009.04.025. View

19.

van Gelder B, Scheffer M, Meijer A, Bracke F . Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in cardiac resynchronization therapy. Heart Rhythm. 2007; 4(4):454-60. DOI: 10.1016/j.hrthm.2006.11.023. View

20.

Moss A, Hall W, Cannom D, Klein H, Brown M, Daubert J . Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009; 361(14):1329-38. DOI: 10.1056/NEJMoa0906431. View