LAUSR

The presence of coronary sinus (CS) venous valves is a major cause of coronary sinus reducer (SR) implant failure. A 69-year-old man with previ-ous revascularization with triple coronary artery bypass grafting presented with limiting effort angina refractory to treatment. Recent angiography due to effort angina showed the occlusion of the two saphenous vein grafts and patency of the arterial graft to the left anterior descending coronary artery (LAD) and severe diffuse disease at the LAD and left circumflex coronary artery, which were con sidered not suitable to further revascularization. Due to persistent and refractory symptoms despite maximal medical therapy and objective evidence of anterolateral-induced ischemia, the patient was planned for SR implant. A 9 Fr sheath was inserted through the right jugular vein and a multipurpose 6 F catheter was advanced into the atrium. The CS venography