case_images: PMC10801087_01
case_images: A: Contrast cardiac computed tomography (CT) image of anterior-posterior view showing persistent left superior vena cava and a coronary sinus (CS) without a lateral vein. CS branches are manually traced on a 2D image and reconstructed to a 3D image. B: Venography from the mid CS trunk. C: Occlusive venogram failed to visualize the CS branch. D: Noncontrast cardiac CT image using the fat description method of the left posterolateral view. Red arrowheads show the anterior intraventricular vein orifice. Yellow arrowheads show the right ventricular lead. White arrowheads show the middle cardiac vein.
case_images: gr1.jpg
case_images: PMC10801087_01_gr1.jpg
case_images: fig1
case_images: CS branch. Contrast-enhanced cardiac computed tomography (CT) revealed a persistent left superior vena cava (PLSVC) and a CS without a lateral vein (Figure 1A). Multidirectional venography using a guiding catheter positioned in the mid CS trunk did not demonstrate AIV (Figure 1B). Moreover, the occlusive venography failed to visualize the CS branch because the balloon diameter was smaller than the CS trunk diameter (Figure 1C).
case_images: A: Fluoroscopy of intravascular ultrasound (IVUS) and guiding catheter at left anterior oblique view. B: IVUS image of the same level of (A). C: IVUS image close to anterior intraventricular vein (AIV). Note the AIV orifice is sandwiched between left circumflex (LCX) and coronary sinus (CS) trunk and shows eccentric narrowing.
case_images: gr2.jpg
case_images: PMC10801087_01_gr2.jpg
case_images: fig2
case_images: AIV orifice by rotating the child catheter, which had a 130-degree bend at the tip (Medtronic) (Figure 2A and 2B). A second 0.014-inch wire (Cruise; Asahi Intecc, Aichi, Japan) was inserted into the AIV under real-time guidance of the IVUS image. Simultaneously, the IVUS image revealed venous stenosis at the AIV orifice because it was sandwiched between the left circumflex artery and the CS trunk (Figure 2C).
case_images: Advanced anchor balloon technique. A: The balloon was inflated at the anterior intraventricular vein (AIV) orifice as an anchor at the stenotic lesion. B: Balloon tail in contact with child catheter owing to gentle traction on the balloon and gentle forward pressure on the child catheter with continuous force. C: When the balloon was deflated, the child catheter was drawn automatically into the AIV, passing through the stenotic lesion.
case_images: gr3.jpg
case_images: PMC10801087_01_gr3.jpg
case_images: fig3
case_images: The balloon was then inflated at the AIV orifice and used as an anchor balloon at the point where the stenotic lesion was located (Figure 3A). Subsequently, we applied gentle traction to the balloon and gentle forward pressure to the child catheter so that the balloon tail came into contact with the child catheter tip, and traction and forward pressure was exerted (Figure 3B). Consequently, the catheter was drawn into the AIV, and it passed through the stenotic lesion (Figure 3C).