Newly Published
Images in Anesthesiology  |   August 2019
Seeing Double: The Clinical Conundrum of the Double-barrel Coronary Sinus
Author Notes
  • From the Department of Anesthesiology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas.
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Correspondence: Address correspondence to Dr. Hankins: samuel.hankins@va.gov
Article Information
Images in Anesthesiology / Cardiovascular Anesthesia / Central and Peripheral Nervous Systems / Ophthalmologic Anesthesia
Images in Anesthesiology   |   August 2019
Seeing Double: The Clinical Conundrum of the Double-barrel Coronary Sinus
Anesthesiology Newly Published on August 5, 2019. doi:10.1097/ALN.0000000000002931
Anesthesiology Newly Published on August 5, 2019. doi:10.1097/ALN.0000000000002931
The accompanying modified mid-esophageal four-chamber transesophageal echocardiography image shows two coronary sinuses emptying into the right atrium where normally there is one. As shown in panel A, both sinuses run parallel in the AV groove inferior to the left atrium (Supplemental Digital Content, https://links.lww.com/ALN/C43). This rare anomaly, referred to as “double-barrel coronary sinus,” was discovered during a coronary artery bypass graft procedure in which retrograde cardioplegia was planned. Double-barrel coronary sinus arises when the great cardiac vein fails to combine with the left horn of the sinus venosus during the 10th week of development, and is described in full elsewhere.1–3  Despite the obvious perils of cannulating the “false” sinus, criteria for determining the “true” coronary sinus by transesophageal echocardiography have not yet been published.2