Response to Letter by: Chase, doi: 10.1016Z/j.jsha.2012.01.001

In reply to the letter by dr. chase, we agree that differences between individuals in the anatomy of the right atrium can make cannulation of the coronary sinus difficult in some cases. we routinely use a medium curve deflectable catheter. in difficult cases we perform imaging of the coronary sinus by contrast injection using an amplaz left ii coronary catheter from a femoral approach. long sheaths such as the sl0 are very rarely required (<1% of cases) in our institution. the experience of the operator is more important than these technical details. in our institution, an experienced operator (>1000 cases as first operator) is available for all procedures to avoid having to revert to subclavian access for coronary sinus cannulation.