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Salehi M, Ochieng L, Gosling R, Morgan K. Coronary sinus thrombosis as a complication of myocardial infarction-associated ventricular wall rupture: an unusual cause of collapse. BMJ Case Rep 2022; 15:e248815. [PMID: 35351764 PMCID: PMC8966530 DOI: 10.1136/bcr-2022-248815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 01/31/2023] Open
Abstract
Coronary sinus thrombosis is a rare phenomenon, most commonly occurring following invasive cardiac procedures. Spontaneous thrombosis is extremely rare and little is known about the natural history or optimal management. We present a case of coronary sinus thrombosis occurring in the context of myocardial infarction with concealed ventricular wall rupture.
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Affiliation(s)
- Mahan Salehi
- The Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- The Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Lorraine Ochieng
- The Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Gosling
- The Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
- The Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kenneth Morgan
- The Department of Cardiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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2
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Hart MA, Simegn MA. Pylephlebitis presenting as spontaneous coronary sinus thrombosis: a case report. J Med Case Rep 2017; 11:309. [PMID: 29092714 PMCID: PMC5667030 DOI: 10.1186/s13256-017-1479-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 09/28/2017] [Indexed: 12/21/2022] Open
Abstract
Background Coronary sinus thrombosis is a rare phenomenon. When identified, it most often is a complication of infective endocarditis or procedural intervention. We present an unusual and unreported case of spontaneous coronary sinus thrombosis as embolic sequela of an intra-abdominal infectious process. Case presentation We report a case of a 61-year-old white woman with a history of end-stage renal disease on hemodialysis, paroxysmal atrial fibrillation not on long-term systemic anticoagulation, and history of recurrent diverticulitis that presented with acute onset abdominal pain and nausea. Computed tomography of her abdomen and pelvis with intravenous contrast was negative for acute intra-abdominal pathology, but incidentally identified an oval-shaped filling defect at the ostium of the coronary sinus suspicious for thrombus or mass which was confirmed on subsequent transesophageal echocardiogram. In light of her concomitant transaminitis but otherwise negative workup, the mass was believed to be thromboembolic in nature, originating within the hepatic venous system as a manifestation of recurrent diverticulitis with associated pylephlebitis and ultimately lodging into the coronary sinus. With the newly detected thrombus and history of paroxysmal atrial fibrillation, she was started on warfarin for therapeutic systemic anticoagulation that resolved her clot by 3-month follow up. Conclusions Although coronary sinus thrombosis is rare, a high index of suspicion and close scrutiny of the venous system in patients with intra-abdominal infectious processes would prevent delay in management of this potentially serious complication. The discussion of this case highlights the anatomy of the cardiac venous system, the pathophysiology of thrombus formation, and the utility of transesophageal echocardiography in confirming a diagnosis and assessing treatment efficacy.
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Affiliation(s)
- Michael A Hart
- General Internal Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN, 55415, USA.
| | - Mengistu A Simegn
- Cardiology, Hennepin County Medical Center, 701 Park Avenue, Orange 5, Minneapolis, MN, 55415, USA
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Kranig W, Amberger J, Awad K, Wolff E, Vahlkamp K, Thale J, Küpper B. Implantation meets intervention: reopening of a thrombotic ostial occlusion of coronary sinus by angioplasty achieved improvement of cardiac venous drainage and allowed transvenous CRT implantation. Clin Res Cardiol 2017; 106:1033-1039. [PMID: 28921055 DOI: 10.1007/s00392-017-1141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Wolfgang Kranig
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany.
| | - Johannes Amberger
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Khaled Awad
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Enrik Wolff
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Kerstin Vahlkamp
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Joachim Thale
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
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4
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Martin J, Nair V, Edgecombe A. Fatal coronary sinus thrombosis due to hypercoagulability in Crohn's disease. Cardiovasc Pathol 2016; 26:1-3. [PMID: 27776257 DOI: 10.1016/j.carpath.2016.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 09/14/2016] [Accepted: 09/29/2016] [Indexed: 12/26/2022] Open
Abstract
A 27-year-old male, admitted to hospital for a psoas muscle abscess secondary to Crohn's disease, suddenly died while in hospital. A medicolegal autopsy showed coronary sinus thrombosis. Coronary sinus thrombosis is rare and is usually associated with invasive cardiac procedures. Coronary sinus thrombosis associated with Crohn's disease has not been reported. Autopsy examination of the coronary sinus is advocated, especially in individuals with hypercoagulable states.
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Affiliation(s)
- Janet Martin
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8S 4L8
| | - Vidhya Nair
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8S 4L8; Hamilton Health Sciences, Hamilton, Ontario, Canada LBL 2X2
| | - Allison Edgecombe
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada L8S 4L8; Hamilton Health Sciences, Hamilton, Ontario, Canada LBL 2X2.
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Kim SY, Song JW, Jang YS, Kwak YL. Formation of intracardiac thrombus during cardiopulmonary bypass despite full heparinization and adequate activated clotting time -A case report-. Korean J Anesthesiol 2012; 62:571-4. [PMID: 22778896 PMCID: PMC3384798 DOI: 10.4097/kjae.2012.62.6.571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 06/20/2011] [Accepted: 06/21/2011] [Indexed: 11/28/2022] Open
Abstract
We reports a case of a newly formed thrombus in the left atrial appendage during cardiopulmonary bypass detected by transesophageal echocardiography in a patient with chronic atrial fibrillation and mitral stenosis. This case alerts the anesthesiologists of possible thrombus formation despite full heparinization during cardiac surgery and the importance of a comprehensive echocardiography examination.
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Affiliation(s)
- So Yeon Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
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6
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A novel application of cerebral oximetry in cardiac surgery. Ann Thorac Surg 2010; 90:1700-1. [PMID: 20971298 DOI: 10.1016/j.athoracsur.2010.04.095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/18/2010] [Accepted: 04/23/2010] [Indexed: 11/23/2022]
Abstract
We report a novel use of cerebral oximetry in cardiac surgery using the Fore-Sight absolute cerebral oximeter (CAS Medical Systems Inc, Branford, CT). A patient with a persistent left superior vena cava underwent mitral and aortic valve replacement. We decided to tape and occlude the persistent left superior vena cava and used cerebral oximetry to compare left and right hemispheric oxygen saturation levels to ensure that cerebral perfusion was not impaired. The procedure was uneventful, and the patient was extubated 8 hours later without neurocognitive deficit.
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Yeo KK, Davenport J, Raff G, Laird JR. Life-threatening coronary sinus thrombosis following catheter ablation: case report and review of literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2010; 11:262.e1-5. [DOI: 10.1016/j.carrev.2010.01.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2009] [Accepted: 01/07/2010] [Indexed: 11/30/2022]
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Spontaneous Bacterial Pericarditis and Coronary Sinus Endocarditis Caused by Oxacillin-Susceptible Staphylococcus aureus. Case Rep Med 2010; 2010:984562. [PMID: 20585370 PMCID: PMC2878699 DOI: 10.1155/2010/984562] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 04/08/2010] [Indexed: 01/30/2023] Open
Abstract
This paper describes a case of a 44-year-old male patient previously healthy admitted with an unusual spontaneous acute bacterial pericarditis associated with coronary sinus mass. Two-dimensional echocardiography showed large loculated pericardial effusion with signs of diastolic restriction and an image suggesting vegetation in topography of the right atrium coronary sinus. Pericardial drainage, coronary sinus vegetation resection, and antibiotic therapy with Oxacillin were performed due to Oxacillin-susceptible Staphylococcus aureus identified on the pericardial effusion and blood culture. This is a rare condition and a unique combination of a spontaneous acute bacterial pericarditis with coronary sinus endocarditis without cardiac valve compromise.
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Jones D, Amsterdam E, Young JN. Septic thrombophlebitis of the coronary sinus with complete recovery after surgical intervention. Cardiol Rev 2005; 12:325-6. [PMID: 15476571 DOI: 10.1097/01.crd.0000128237.44935.98] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This case represents a unique presentation of septic thrombophlebitis of the coronary sinus in that the infection was localized to the coronary sinus, the etiology was unclear, and the patient recovered uneventfully after surgery.
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Affiliation(s)
- David Jones
- Cardiology Associates, Coeur d'Alene, Idaho, USA
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Neri E, Tripodi A, Tucci E, Capannini G, Sassi C. Dramatic improvement of LV function after coronary sinus thromboembolectomy. Ann Thorac Surg 2000; 70:961-3. [PMID: 11016343 DOI: 10.1016/s0003-4975(00)01639-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We present the case of a 79-year-old man suffering from chronic atrial fibrillation, severe left ventricular dysfunction, massive right atrial thrombosis, and pulmonary hypertension. Complete coronary sinus thrombosis was found incidentally during preoperative screening. Successful coronary sinus, right atrial, and pulmonary operative embolectomy was followed soon after by a dramatic improvement of cardiac performance; the patient's left ventricular function recovery, in particular, suggests that cardiac venous system played an important role in the genesis of myocardial impairment.
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Affiliation(s)
- E Neri
- Thoracic and Cardiovascular Department, University Hospital, Siena, Italy.
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11
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Unexpected Sudden Death from Coronary Sinus Thrombosis. An Unsual Complication of Central Venous Catheterization. J Forensic Sci 2000. [DOI: 10.1520/jfs14799j] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Greenberg M, Raggio C. Antecubital central venous catheter placement complicated by a persistent left superior vena cava. J Neurosurg Anesthesiol 2000; 12:114-7. [PMID: 10774606 DOI: 10.1097/00008506-200004000-00008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 14-year-old female in whom we encountered a persistent left superior vena cava during placement of a central venous catheter is presented. The patient had a history of coarctation of the aorta, but the left superior vena cava was unknown. Since the incidence of persistent left superior vena cava in patients with congenital heart disease is ten times as great as those without, in this patient population it may be useful to obtain radiographic confirmation of catheter position before use.
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