Unroofed Coronary Sinus in a Patient With Prior Surgical Closure of Secundum Atrial Septal Defect

Abstract

An unroofed coronary sinus is an uncommon congenital cardiac anomaly. It leads to a left to right shunt like an atrial septal defect (ASD) and comprises <1% of all ASDs. It can also additionally create a pathway for paradoxical embolization to the brain and other attendant complications. Here, we present the case of an asymptomatic 40-year-old-male with a history of prior surgical closure of an ostium secundum ASD who was referred for preoperative evaluation for non-cardiac surgery. An unroofed coronary sinus with persistent left superior vena cava (PLSVC) was suspected on transthoracic echocardiography and confirmed by transesophageal echocardiography.

A Surgical Case of Partially Unroofed Coronary Sinus Atrial Septal Defect in an Elderly Patient Diagnosed by Preoperative Contrast-Enhanced Computed Tomography

“…1) It is often difficult to have a distinct preoperative diagnosis of unroofed CSASD, and is often confirmed intraoperatively. [2][3][4][5] The complete surgical repair inevitably requires the precise detection of anatomical characteristics of unroofed CSASD, because detailed surgical decision making is mandatory for such a complex operative procedure to be safely performed. Therefore, it is considered essential to establish the diagnostic methodology to delineate the precise anatomical features of unroofed CSASD.…”

“…It is often difficult to make an accurate diagnosis of unroofed CSASD with conventional echocardiography. [2][3][4][5] However, preoperative precise detection of unroofed CSASD is considered essential for the surgical repair to be safely performed. Herein, we report a case with unroofed CSASD in which preoperative contrast-enhanced CT was useful to determine the operative procedure.…”

Misdiagnosis of persistent left superior vena cava with unroofed coronary sinus as a coronary sinus‐type atrial septal defect

“…Commonly, PLSVC drains into the right atrium (RA) via the coronary sinus (CS), and when isolated, it is usually asymptomatic, and may be detected incidentally 1 . Unroofed coronary sinus syndrome (UCSS) is an uncommon CHD which leads to a left to right shunt at the atrial level, and comprises <1% of all atrial septal defect (ASD) types 2,5 . When UCSS is associated with PLSVC, it is difficult to detect the diagnosis by transthoracic echocardiography (TTE) 1 .…”

“… 1 Unroofed coronary sinus syndrome (UCSS) is an uncommon CHD which leads to a left to right shunt at the atrial level, and comprises <1% of all atrial septal defect (ASD) types. 2 , 5 When UCSS is associated with PLSVC, it is difficult to detect the diagnosis by transthoracic echocardiography (TTE). 1 Herein, we present a case of a 2‐year‐old patient with preoperative diagnosis of coronary sinus‐type ASD; however, PLSVC draining into the left atrium (LA) was detected during surgery.…”