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Ann Thorac Surg 2006;82:191-196
© 2006 The Society of Thoracic Surgeons

Original article: Cardiovascular

Surgical Approach to Left Ventricular Inflow Obstruction Due to Dilated Coronary Sinus

Florentino J. Vargas, MD a , * , Jorge Rozenbaum, MD a , Ricardo Lopez, MD a , Miguel Granja, MD b , Ana De Dios, MD b , Beatriz Zarlenga, MD b , Enrique Flores, MD b , Enrique Fischman, MD b , Eduardo Kreutzer, MD b

a Division of Cardiovascular Surgery, Hospital de Niños Pedro Elizalde, Buenos Aires, Argentina
b Division of Cardiology, Hospital de Niños Pedro Elizalde, Buenos Aires, Argentina

Accepted for publication February 27, 2006.

* Address correspondence to Dr Vargas, Pediatric Cardiovascular Surgery and Cardiopumonary Transplantation, Hospital de Niños Pedro Elizalde, San Martin 1353, Banfield, Buenos Aires 1828, Argentina (Email: florentino_jose{at}yahoo.com).

BACKGROUND: Left superior vena cava draining to a dilated coronary sinus can cause left ventricular inflow obstruction. Our purpose is to report 4 severely ill patients with this malformation who were operated upon and in whom repair was accomplished using an original surgical approach.

METHODS: An operative procedure was designed, which included complete resection of the wall of the coronary sinus along its entire extension in the left atrium; division of the left superior vena cava; and establishment of the left superior vena cava-right atrial continuity by a wide left superior vena cava-right atrial appendage anastomosis. The series included 1 patient with interrupted inferior vena cava-hemiazygous continuation to left superior vena cava.

RESULTS: There were no deaths. Absence of residual left ventricular inflow obstruction was demonstrated at follow-up in all cases, together with an unobstructed left superior vena cava-right atrial appendage-right atrial connection.

CONCLUSIONS: A predictable relief of the left ventricular inflow obstruction, together with preservation of an adequate drainage for the systemic venous return, were both achieved with this repair.




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Ann. Thorac. Surg., July 1, 2006; 82(1): 196 - 196.
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