Coronary sinus ostial atresia is a rare encounter in the intervention laboratory and is often linked with several congenital cardiac anomalies such as persistent left superior vena cava among others. Over the course of Cardiac Resynchronization Therapy (CRT), our case had the coronary sinus directly communicating with the superior vena cava through an anomalous bridging vein in the absence of a persistent left superior vena cava, along with an atretic right atrial ostium. Also, of interest was the minimal amount of technical challenge offered by such an anomaly for CRT lead implantation provided an otherwise favorable coronary anatomy.
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