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Percutaneous transseptal mitral commissurotomy in a patient with absent right superior vena cava and aneurysmally dilated coronary sinus

Abstract

Percutaneous transseptal mitral commissurotomy (PTMC) is the first line of treatment for selected patients of rheumatic mitral stenosis. Transseptal puncture is the most crucial step for performing a safe and successful PTMC. The distorted cardiac anatomy can lead to technical difficulties and increase the risk of serious complications. Isolated persistent left superior vena cava in a patient with visceroatrial situs solitus is rare. We report a case of successful PTMC in a patient with distorted anatomy due to aneurysmal dilatation of coronary sinus secondary to the persistent left superior vena cava, absent right superior vena cava and bulging interatrial septum.

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Conflict of interest

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Author information

Correspondence to Vivek Singla.

Electronic supplementary material

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Video 1: Transthoracic echocardiogram in parasternal long axis view showing dilatation of left atrium and coronary sinus alongwith diastolic doming of anterior mitral leaflet and turbulent flow across mitral valve

Video 2: Transthoracic echocardiogram in parasternal short axis view showing narrowed MV orifice and dilated coronary sinus

Video 3: Transthoracic echocardiogram in apical-4-chamber (A4C) view showing dilatation of left atrium, right atrium, right ventricle and coronary sinus. Interatrial bulge is also seen

Video 4: Right subclavian venogram showing absent right superior vena cava (SVC) and right innominate vein draining into left SVC which in turn drained into RA through an aneurysmally dilated coronary sinus

Video 5: Cine loop in RAO view showing dye from Brokenbrough needle causing opacification of dilated coronary sinus and left superior vena cava

Video 6: Cine loop in RAO view showing dye from Brokenbrough needle causing opacification of left atrium after successful transseptal puncture

Video 7: Cine film in RAO view showing mitral valvotomy using Accura balloon technique

Video 1: Transthoracic echocardiogram in parasternal long axis view showing dilatation of left atrium and coronary sinus alongwith diastolic doming of anterior mitral leaflet and turbulent flow across mitral valve

Video 2: Transthoracic echocardiogram in parasternal short axis view showing narrowed MV orifice and dilated coronary sinus

Video 3: Transthoracic echocardiogram in apical-4-chamber (A4C) view showing dilatation of left atrium, right atrium, right ventricle and coronary sinus. Interatrial bulge is also seen

Video 4: Right subclavian venogram showing absent right superior vena cava (SVC) and right innominate vein draining into left SVC which in turn drained into RA through an aneurysmally dilated coronary sinus

Video 5: Cine loop in RAO view showing dye from Brokenbrough needle causing opacification of dilated coronary sinus and left superior vena cava

Video 6: Cine loop in RAO view showing dye from Brokenbrough needle causing opacification of left atrium after successful transseptal puncture

Video 7: Cine film in RAO view showing mitral valvotomy using Accura balloon technique

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Srinivas, B.C., Singla, V., Reddy, B. et al. Percutaneous transseptal mitral commissurotomy in a patient with absent right superior vena cava and aneurysmally dilated coronary sinus. Cardiovasc Interv and Ther 28, 419–421 (2013) doi:10.1007/s12928-013-0196-6

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Keywords

  • PTMC
  • Mitral stenosis
  • Persistent left superior vena cava
  • Cardiac tamponade
  • Septal puncture