Coronary sinus occlusive

Fig. 5.9 RAO and LAO images of a coronary sinus occlusive venogram in a postoperative patient demonstrating a large vein of Marshall (arrow) that could have easily been mistaken for the true coronary sinus. Note the complex lateral venous anatomy. Successful lead implantation was achieved in a lateral venous branch.

Benedict et al. (1986) modified the electrical induction of thrombosis by use of two Doppler flow probes proximal and distal to the needle electrode in order to measure changes in blood flow velocity. The electrical current was stopped at 50 % increase in flow velocity and thrombosis then occurred spontaneously. The important role of serotonin was demonstrated by increases in coronary sinus serotonin levels just prior to occlusion. 

Coronary blood flow is closely tied to oxygen needs of the heart. Changes in oxygen balance lead to very rapid changes in coronary blood flow. Although a number of mediators may contribute to these changes, the most important ones are likely to be adenosine, other nucleotides, nitric oxide, prostaglandins, CO2, and H. Adenosine, which is formed from adenosine triphosphate (ATP) and adenosine monophosphate (AMP) under conditions of ischemia and stress, is a potent vasodilator that links decreased perfusion to metabolically induced vasodilation, or reactive hyperemia. The synthesis and release of adenosine into coronary sinus venous effluent occur within seconds of coronary artery occlusion, and about 30% of the hyperemic response can be blocked by metabolic blockers of adenosine. " ... 

De Voogt G, Ruiter JH (2006) Occlusion of the coronary sinus a complication of resynchronization therapy for severe heart failure. Europace 8 456-458... 

Before percutaneous transluminal coronary angioplasty, coronary sinus concentrations of adenosine and hypoxanthine were 176 34nMol and 723 73nMol, respectively (Bardenheuer etal. 1994). 30 s after balloon deflation adenosine concentrations were enhanced in close proportion to the duration of coronary occlusion 326 47nM [30 s], 531 80nM [60 s], and 793 150 nM [90 s], respectively. During reperfusion similar results were also obtained in the case of hypoxanthine and uric acid. 

If occlusive coronary sinus venography is performed, care must be exercised to assure the relatively stiff tip of the balloon catheter does not engage a small lateral branch vessel or dissect the wall of the coronary sinus before balloon... 

Fig. 5.8 RAO and LAO images of a coronary sinns occlusive venogram demonstrating a near parallel orientation of a lateral venous branch that originates close to the ostium of the coronary sinus (seen best in the LAO projection).

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