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J Thorac Cardiovasc Surg 2004;127:959-962
© 2004 The American Association for Thoracic Surgery

Surgery for congenital heart disease

Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus

^a Michael E. DeBakey Department of Surgery, Division of Congenital Heart Surgery, Baylor College of Medicine, Houston, Tex, USA
^b Department of Pediatrics, Section of Pediatric Cardiology, Baylor College of Medicine, Houston, Tex, USA

Received for publication May 13, 2003; revisions received June 16, 2003; revisions received June 26, 2003; accepted for publication July 17, 2003.

^* Address for reprints: Daniel J. DiBardino, MD, Division of Congenital Heart Surgery, Texas Children's Hospital, 6621 Fannin St, MC WT 19345H, Houston, TX 77030, USA
djd{at}bcm.tmc.edu

BACKGROUND: It has previously been suggested that significant dilatation of the coronary sinus can contribute to left ventricular inflow obstruction and is amenable to surgical correction. The purpose of this study was to review our experience with this rare condition.

METHODS: Since 1995, 6 patients have undergone coronary sinus reduction for concerns of obstruction with other concomitant intracardiac repairs. Preoperative echocardiography identified a significantly dilated left superior vena cava to the coronary sinus in 5 patients (83%) and an abnormal mitral valve in 4 patients (67%); these resulted in abnormal Doppler inflow patterns. Preoperative cardiac catheterization was performed in 5 patients and revealed increased atrial "a" waves, with a gradient to the left ventricular end-diastolic pressure in each case. At the time of surgery, coronary sinus angioplasty was performed in all patients.

RESULTS: There were no deaths, and there was no major morbidity. Follow-up imaging revealed no significant left ventricular inflow obstruction in any patient.

CONCLUSIONS: We conclude that dilatation of the coronary sinus can become hemodynamically significant and that coronary sinus angioplasty is a safe and effective technique.

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