A large vein of Marshall aneurysm
Singh G, Khan A, Singh MK, Maskoun W, Schuger CD. A large vein of Marshall aneurysm. J Interv Card Electrophysiol. 2018;51(1):S118-S119.
J Interv Card Electrophysiol
Background: Vein of Marhsall (VOM) is a remnant ofanterior cardinal vein and joins coronary sinus at the level of valve of Vieussens. VOM is usually a small caliber veinand can participate in atrial arrythmia's Objective: N/AMethods: N/A Results: An 85-year-old male with hypertension, diabetes mellitus and ischemic cardiomyopathy with AV block underwent biventricular ICD in 2015 who presented for generator replacement due to device recall. He also underwent coronary sinus lead revisiondue to elevated threshold. Coronary sinus cannulation was difficult due to posterior take off and venogram showed a large aneurysmal VOM as shown in Fig. A and B. The coronary sinus main body take off was anterior which was eventually cannulated, and a CS lead was implanted in a high anterolateral branch due to absence of pacing capture in mid posterolateral wall. Pacing thresholds were found to be adequate in anterolateral branch. Conclusions: This case highlights presence of a large vein of Marshall aneurysmal dilatation which could be mistaken for a main coronary sinus and inappropriate cannulation can lead to adverse outcomes due to vein perforation.