LAUSR

BACKGROUND Coronary sinus (CS) ostial atresia/anomalies prevents access to the CS from the right atrium (RA) for left ventricular (LV) lead implantation. Some patients with CS ostial anomalies also have a small persistent left superior vena cava (sPLSVC). OBJECTIVE Describe CS ostial anomalies and sPLSVC as an opportunity for LV lead implantation and unrecognized source of stroke. METHODS Twenty patients with CS ostial anomalies and sPLSVC were identified. Clinical information, imaging methods, LV lead implantation techniques and complications were summarized. RESULTS Forty percent had at least one previously unsuccessful LV lead placement. In 70%, sPLSVC was identified by catheter manipulation and contrast injection in the left brachiocephalic vein, and in 30% by levophase CS venography. In 30%, sPLSVC were associated with drainage from the CS into the left atrium (LA). When associated with CS ostial anomalies, sPLSVC diameter averaged 5.6±3mm. sPLSVC was used for successful LV lead implantation in 90% of cases. In 80%, LV lead was implanted down sPLSVC and in 20% sPLSVC was used to access the CS from the RA. Presumably due to unrecognized drainage from CS to LA, one patient experienced a stroke during implantation via sPLSVC. CONCLUSION When CS ostial anomalies prevent access to CS from RA, sPLSVC can be used to successfully implant LV leads. In some, CS partially drains into the LA and stroke can occur spontaneously or during lead intervention. It is important to distinguish sPLSVC associated with CS ostial anomalies from isolated PLSVC.