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Case Reports
. 2022 Jan-Feb;22(1):58-60.
doi: 10.1016/j.ipej.2021.11.003. Epub 2021 Nov 12.

Marshall to the rescue in cardiac resynchronization therapy: Left ventricular lead placement in coronary sinus ostial atresia

Ranjit Kumar Nath  1 , Ajay Pratap Singh  2 , Dheerendra Kuber  1 , Vatsal Kayal  1
Affiliations
Case Reports

Marshall to the rescue in cardiac resynchronization therapy: Left ventricular lead placement in coronary sinus ostial atresia

Ranjit Kumar Nath et al. Indian Pacing Electrophysiol J. 2022 Jan-Feb.

Erratum in

Abstract

This case highlights the importance of proper identification of congenital anomalies of the coronary sinus for the successful placement of left ventricular lead during cardiac resynchronization therapy device implantation. We discuss an alternate route for left ventricular lead placement via the vein of Marshall when the coronary sinus ostium in the right atrium was atretic and was facing difficulty initially in detecting the anomaly.

Keywords: Cardiac resynchronization therapy; Congenital anomaly; Coronary sinus; Left ventricular lead placement.

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Conflict of interest statement

Declaration of competing interest None.

Figures

Fig. 1
Fig. 1
Levophase of left coronary angiogram in LAO (left anterior oblique) projection: Showing two separate openings of the anterior interventricular vein (white arrows) and middle cardiac vein (white arrowheads) along with an atretic coronary sinus (CS) ostium body (red arrows). Target good size lateral vein (black arrowheads) and Vein of Marshall from the body of CS draining towards left innominate vein (black arrows).
Fig. 2
Fig. 2
Fluoroscopic Image: Selective hooking of Vein of Marshall (black arrows) using a Judkins Right (JR white arrows) catheter.
Fig. 3
Fig. 3
Fluoroscopic image: Engaging the Vein of Marshall using the coronary sinus sheath (red arrow) and cannulating target lateral vein with a guidewire (black arrow) using a 90° vein sub-selector.
Fig. 4
Fig. 4
Fluoroscopic Image: Showing right atrial lead (Black arrows), right ventricular lead (white arrows), and left ventricular lead (red arrows) with an adequate loop in coronary sinus body.
See this image and copyright information in PMC

References

    1. Gamble J.H.P., Herring N., Ginks M., Rajappan K., Bashir Y., Betts T.R. Procedural success of left ventricular lead placement for cardiac resynchronization therapy: a meta-analysis. JACC Clin Electrophysiol. 2016;2(1):69–77. doi: 10.1016/j.jacep.2015.08.009. Epub 2015 Nov 10. PMID: 29766856. - DOI - PubMed
    1. Irwin R.B., Greaves M., Schmitt M. Left superior vena cava: revisited. European Heart J Cardiovas Imag. 2012;13(Issue 4):284–291. doi: 10.1093/ehjci/jes017. - DOI - PubMed
    1. Shum J.S., Kim S.M., Choe Y.H. Multidetector CT and MRI of ostial atresia of the coronary sinus, associated collateral venous pathways and cardiac anomalies. Clin Radiol. 2012;67(12):e47–52. doi: 10.1016/j.crad.2012.07.013. Epub 2012 Sep 10. PMID: 22974567. - DOI - PubMed
    1. Jha N.K., Gogna A., Tan T.H., Wong K.Y., Shankar S. Atresia of coronary sinus ostium with retrograde drainage via persistent left superior vena cava. Ann Thorac Surg. 2003;76(6):2091–2092. doi: 10.1016/s0003-4975(03)01040-3. - DOI - PubMed
    1. Petrac D., Radeljic V., Pavlovic N., Manola S., Delic-Brkljacic D. Persistent left superior vena cava in patients undergoing cardiac device implantation: clinical and long-term data. Cardiol Res. 2013;4(2):64–67. PMID: 28352422; PMCID: PMC5358215. - PMC - PubMed

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