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Abstract: Poster Presentations |

THE DILATED CORONARY SINUS: UTILITY OF CORONARY SINUS CROSS-SECTIONAL AREA AND ECCENTRICITY INDEX IN DIFFERENTIATING RIGHT ATRIAL PRESSURE OVERLOAD FROM PERSISTENT LEFT SUPERIOR VENA CAVA FREE TO VIEW

Brian C. Kolski; Mireille Anawati, MD; Bharam Khadivi, MD; Lori B. Daniels, MD; Anthony N. Demaria, MD; Daniel G. Blanchard, MD
Author and Funding Information

UCSD, San Diego, CA


Chest


Chest. 2009;136(4_MeetingAbstracts):60S. doi:10.1378/chest.136.4_MeetingAbstracts.60S-a
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Abstract

PURPOSE:  Pulmonary hypertension and elevated right atrial(RA) pressure cause dilation of the coronary sinus(CS), which is well-visualized on 2D echocardiography. Congenitally persistent connection of the left superior vena cava(LSVC) to the CS occurs in ∼0.3% of the population, and causes dilation of the CS. This study evaluates the usefulness of coronary sinus cross-sectional area(CSCSA) and eccentricity index(EI) in differentiating RA pressure overload from persistent left SVC in patients with dilated CS.

METHODS:  We prospectively identified 13 patients with a dilated CS on echo over one year. Off-line analysis was used to measure (1) CSCSA at end-diastole in the parasternal long axis plane, and (2) CS eccentricity index (CSEI) in the same plane. This was defined as B/A, where A is the widest diameter and major axis of the CS, and B is the diameter of the minor axis (perpendicular to and bisecting A at its midpoint). Group 1(7 pts) had dilated CS with documented RA pressure overload. Group 2 (6 pts) had persistent LSVC, confirmed by either computed tomography or injection of agitated saline in the left antecubital vein. Tricuspid regurgitation(TR) velocities and IVC diameters were measured in all patients.

RESULTS:  Tricuspid regurgitation (TR) velocity in Group 1 was 4.0 ± 0.7m/s, compared to 2.7 ± 0.6 in Group 2 (p = 0.02). IVC diameters were 2.5 ± 0.9 cm in Group 1 and 1.8 ± 0.3 cm in Group 2 (p = 0.3). CSCSA was significantly smaller in Group 1 (1.8 ± 1.9 cm2) than in Group 2 (5.0 ± 2.8 cm2, p = 0.045). Also, CSEI was higher in Group 1 than in Group 2 (0.9 ± 0.03 vs. 0.6 ± 0.1, p = 0.001). Between these 2 latter parameters, CSEI was more accurate in discriminating patients with elevated RA pressure vs. persistent LSVC: CSEI was > 0.8 in all Group 1 pts and < 0.8 in all Group 2 pts (sensitivity and specificity=100%).

CONCLUSION:  CSCSA and EI vary in patients with dilated CS. Patients with persistent LSVC have a significantly higher CS CSA than those with elevated RA pressure.

CLINICAL IMPLICATIONS:  Coronary sinus cross-sectional area and eccentricity index can be effectively used to differentiate right atrial pressure overload from congenitally persistent LSVC.

DISCLOSURE:  Brian Kolski, No Financial Disclosure Information; No Product/Research Disclosure Information

Tuesday, November 3, 2009

12:45 PM - 2:00 PM


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