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Ibrahim IA, Howladar MT, Alsaery TS, Anwar A, Ahmad W. Simultaneous Identification of Unroofed Coronary Sinus Atrial Septal Defect and Atrial Septal Defect Secundum Using Cardiac Computed Tomography Angiography. Cureus 2024; 16:e52575. [PMID: 38370993 PMCID: PMC10874617 DOI: 10.7759/cureus.52575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 02/20/2024] Open
Abstract
Unroofed coronary sinus (UCS) represents a rare subtype of atrial septal defect (ASD), an adult congenital heart disease characterized by communication between the systemic and pulmonary circulations at the atrial level. This case report presents the unique occurrence of a large, unrepaired ASD secundum and an incidentally identified UCS type II in a 25-year-old female during a cardiac murmur assessment. The diagnosis of ASD secundum was initially made using transthoracic echocardiography (TTE) and was later confirmed with a transesophageal echocardiogram. The identification of the UCS was achieved through the utilization of cardiac computed tomography angiography (CCTA). Ultimately, the patient underwent a successful reroofing procedure using a bovine pericardial patch.
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Affiliation(s)
- Islam A Ibrahim
- Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, SAU
| | | | | | - Ashraf Anwar
- Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, SAU
| | - Waqar Ahmad
- Adult Cardiology, King Fahd Armed Forces Hospital, Jeddah, SAU
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Ding X, Liao Z, Tao Y, Wu X. A case misdiagnosed as hyperthyroid heart disease: Surgical repair of unroofed coronary sinus syndrome with severe tricuspid regurgitation. Clin Case Rep 2023; 11:e7990. [PMID: 37780931 PMCID: PMC10539682 DOI: 10.1002/ccr3.7990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023] Open
Abstract
Unroofed coronary sinus syndrome (URCS), also known as coronary sinus septal defect, is a rare congenital heart disease. Because of its special anatomy and the lack of typical clinical symptoms, the disease is easily missed and misdiagnosed. This case report particularly describes a middle-aged male patient with URCS misdiagnosed for more than 19 years, covered by hyperthyroid heart disease, who subsequently developed uncontrollable symptoms such as chest tightness and shortness of breath and came to our hospital. After a clear diagnosis in our hospital, the patient was successfully cured after treatment with coronary sinus repair and tricuspid valvuloplasty under extracorporeal circulation.
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Affiliation(s)
- Xuejiao Ding
- Department of Ultrasound Imaging, Xiaogan HospitalAffiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
| | - Zhimin Liao
- Department of Cardiothoracic SurgeryXiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
| | - Yichao Tao
- Department of Ultrasound Imaging, Xiaogan HospitalAffiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
| | - Xiaofeng Wu
- Department of Ultrasound Imaging, Xiaogan HospitalAffiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
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Figueras-Coll M, Sabaté-Rotés A, Giralt-Garcia G, Martí-Aguasca G, Betrián-Blasco P. Cierre percutáneo exitoso de comunicación interauricular tipo seno coronario destechado. Rev Esp Cardiol (Engl Ed) 2019. [DOI: 10.1016/j.recesp.2019.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Figueras-Coll M, Sabaté-Rotés A, Giralt-Garcia G, Martí-Aguasca G, Betrián-Blasco P. Successful Percutaneous Closure of a Complete Unroofed Coronary Sinus. ACTA ACUST UNITED AC 2019; 72:970-972. [PMID: 31208855 DOI: 10.1016/j.rec.2019.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 03/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Marc Figueras-Coll
- Unidad de Hemodinámica Pediátrica, Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
| | - Anna Sabaté-Rotés
- Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Gemma Giralt-Garcia
- Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Gerard Martí-Aguasca
- Unidad de Hemodinámica Pediátrica, Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain; Unidad de Hemodinámica, Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Pedro Betrián-Blasco
- Unidad de Hemodinámica Pediátrica, Servicio de Cardiología Pediátrica, Hospital Universitario Vall d'Hebron, Barcelona, Spain
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Yamada K, Miyazaki S, Oboshi M, Suezawa C, Sakakibara Y, Nishimura K. Surgical repair of unroofed coronary sinus with severe mitral regurgitation in an elderly patient. J Cardiol Cases 2019; 19:29-32. [PMID: 30693056 DOI: 10.1016/j.jccase.2018.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022] Open
Abstract
An unroofed coronary sinus (URCS) is a rare anomaly that produces communication between the left atrium (LA) and the coronary sinus (CS), resulting in a left-to-right shunt. Due to the lack of symptoms and particular anatomical characteristics, this disease is difficult to diagnose, and prone to be overlooked. An 85-year-old man was admitted to our hospital because of anorexia and shortness of breath. On physical examination, a systolic murmur was heard at the apex, and pitting edema was present in both legs. Transthoracic echocardiography showed severe regurgitation of the mitral valve and tricuspid valve. Transesophageal echocardiography confirmed a shunt between the LA and the CS. Because of uncontrolled heart failure, we performed surgical repair 50 days after admission. Under cardiopulmonary bypass and heart arrest, the URCS was detected in the LA and directly sutured. Repair of the mitral and tricuspid valves and the Maze procedure were also performed. The patient had a good postoperative course, and has been doing well for 2 years. Transesophageal echocardiography is helpful for diagnosis of URCS. Mitral regurgitation might raise the left atrial pressure and result in increase in shunt flow, causing left and right heart failure in elderly patients. <Learning objective: Diagnosis of an unroofed coronary sinus (URCS) is often overlooked in adult patients because of the lack of symptoms and/or particular anatomical characteristics. We herein describe an octogenarian patient who was diagnosed with URCS in association with severe mitral and tricuspid regurgitation. Transesophageal echocardiography helped to identify the location of the URCS. The cause of the heart failure was mitral regurgitation, which raised the left atrial pressure and increased shunt flow.>.
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Affiliation(s)
- Keiji Yamada
- Department of Cardiology, Takamatsu Red-Cross Hospital, Kagawa, Japan
| | | | - Mai Oboshi
- Department of Cardiology, Takamatsu Red-Cross Hospital, Kagawa, Japan
| | - Chisato Suezawa
- Department of Cardiology, Takamatsu Red-Cross Hospital, Kagawa, Japan
| | - Yutaka Sakakibara
- Department of Cardiovascular Surgery, Takamatsu Red-Cross Hospital, Kagawa, Japan
| | - Kazunobu Nishimura
- Department of Cardiovascular Surgery, Takamatsu Red-Cross Hospital, Kagawa, Japan
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Shah AH, Osten M, Benson L, Alnasser S, Bach Y, Vishwanath R, Van De Bruaene A, Shulman H, Navaranjan J, Khan R, Horlick E. Incidence and Outcomes of Positive Bubble Contrast Study Results After Transcatheter Closure of a Patent Foramen Ovale. JACC Cardiovasc Interv 2018; 11:1095-1104. [DOI: 10.1016/j.jcin.2018.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/05/2018] [Accepted: 03/06/2018] [Indexed: 10/14/2022]
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Chen C, Xu L, Xu Y, Li P, Liu S, You B. Unroofed Coronary Sinus Syndrome: An Easily Corrected Congenital Anomaly But More Diagnostic Suspicion Is Needed. Heart Lung Circ 2017; 27:731-738. [PMID: 28709918 DOI: 10.1016/j.hlc.2017.05.144] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 02/13/2017] [Accepted: 05/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND Unroofed coronary sinus syndrome (URCSS) is a spectrum of cardiac anomalies in which part (partial type) or the entire common wall (complete type) between the coronary sinus (CS) and left atrium is absent. It is commonly associated with a persistent left superior vena cava (PLSVC). The PLSVC can even anomalously connect to the left atrium in complete type anomaly. URCSS has been reported to be associated with delayed diagnosis and life-threatening cerebral injury. The purpose of the present study was to review our experience with surgical correction of this often-concealed malformation and discuss methods for reducing diagnostic omission. METHODS Thirty-six patients with URCSS who underwent surgical treatment from 1998 to 2015 in our institution were enrolled in this retrospective analysis. RESULTS The mean age of the patients was 21.8±20.9 years. Type I anomalies were found in 15 (41.7%) patients, type II in 4 (11.1%), type III in 6 (16.7%), and type IV in 11 (30.6%). A patient presenting with URCSS without other defects was identified in six (16.7%). One patient (2.8%) had a history of paradoxical embolisation. Twenty-five patients (69.4%) were diagnosed before surgery. Ten patients (27.8%) were diagnosed with URCSS intraoperatively. One patient (2.8%) was diagnosed with URCSS by follow-up echocardiography after device occlusion for atrial septal defect. Coronary sinus ostium dilation was the most important clue leading to partial type lesion disclosure intraoperatively. The anomalous PLSVC of 15 patients was repaired using roof tunnel technique in four (26.7%) cases, baffle redirection in eight (53.3%) cases, posterior left atrial wall plicating in two (13.3%) cases, and extracardiac bypass in one (6.7%) case. Postoperative complete atrioventricular block occurred in one patient (2.8%). One patient died postoperatively (2.8%). All patients are doing well after discharge from hospital. CONCLUSIONS Diagnostic suspicion can contribute to lesion disclosure. Surgical correction has good long-term outcomes and low risks.
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Affiliation(s)
- Changcheng Chen
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China.
| | - Lili Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Yi Xu
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Ping Li
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Shuo Liu
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
| | - Bin You
- Department of Cardiac Surgery, Beijing Anzhen Hospital/Capital Medical University, Beijing, China
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Saremi F, Hassani C, Sánchez-Quintana D. Septal Atrioventricular Junction Region: Comprehensive Imaging in Adults. Radiographics 2016; 36:1966-1986. [DOI: 10.1148/rg.2016160010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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9
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Percutaneous management of coronary sinus atrial septal defect: two cases representing the spectrum for device closure and a review of the literature. Cardiol Young 2014; 24:797-806. [PMID: 24666783 DOI: 10.1017/s1047951114000353] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coronary sinus atrial septal defects are the rarest defects of the atrial septum comprising <1% of the five different types of atrial septal defects. Despite the widespread adoption of percutaneous device closure of secundum atrial septal defects, the published experience with percutaneous device closure of coronary sinus atrial septal defects is limited to only a few isolated case reports because of uncertainty regarding safety and efficacy. Open-heart surgical repair remains the treatment of choice for coronary sinus atrial septal defects, although this may not be the only treatment option in selected cases. Herein we describe our own experience with two patients with different clinical presentations and our method of successful percutaneous coronary sinus atrial septal defect closure in each. We then present a review of the anatomic spectrum of coronary sinus atrial septal defects along with a review of contemporary surgical and percutaneous device treatment.
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Total anomalous pulmonary venous connection to the unroofed coronary sinus in a neonate. Pediatr Cardiol 2014; 34:2006-8. [PMID: 23099664 DOI: 10.1007/s00246-012-0551-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/28/2012] [Indexed: 10/27/2022]
Abstract
This report describes the unique case of a newborn with total anomalous pulmonary venous connection to an unroofed coronary sinus associated with Ullrich-Turner syndrome and aortic coarctation. Total anomalous pulmonary venous connection to the unroofed coronary sinus is an extremely uncommon cardiac abnormality. This congenital heart disease is difficult to diagnose and rarely ever reported. Few symptoms are to be expected when it is not associated with other congenital heart defects. This lesion results in a "naturally" corrected total anomalous pulmonary venous return and a coronary sinus atrial septal defect presenting as a left-to-right shunting lesion. Making the diagnosis of this cardiac defect, and if possible, surgical repair is of importance because cardiac dysfunction due to significant atrial left-to-right shunting is a known long-term complication in the older adult patient.
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Giuliani-Poncini C, Perez MH, Cotting J, Hurni M, Sekarski N, Pfammatter JP, Di Bernardo S. Persistent left superior vena cava in cardiac congenital surgery. Pediatr Cardiol 2014; 35:71-6. [PMID: 23821295 DOI: 10.1007/s00246-013-0743-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 06/18/2013] [Indexed: 11/24/2022]
Abstract
Persistent left superior vena cava (LSVC) is a relatively frequent finding in congenital cardiac malformation. The scope of the study was to analyze the timing of diagnosis of persistent LSVC, the timing of diagnosis of associated anomalies of the coronary sinus, and the global impact on morbidity and mortality of persistent LSVC in children with congenital heart disease after cardiac surgery. Retrospective analysis of a cohort of children after cardiac surgery on bypass for congenital heart disease. Three hundred seventy-one patients were included in the study, and their median age was 2.75 years (IQR 0.65-6.63). Forty-seven children had persistent LSVC (12.7 %), and persistent LSVC was identified on echocardiography before surgery in 39 patients (83 %). In three patients (6.4 %) with persistent LSVC, significant inflow obstruction of the left ventricle developed after surgery leading to low output syndrome or secondary pulmonary hypertension. In eight patients (17 %), persistent LSVC was associated with a partially or completely unroofed coronary sinus and in two cases (4 %) with coronary sinus ostial atresia. Duration of mechanical ventilation was significantly shorter in the control group (1.2 vs. 3.0 days, p = 0.04), whereas length of stay in intensive care did not differ. Mortality was also significantly lower in the control group (2.5 vs. 10.6 %, p = 0.004). The results of study show that persistent LSVC in association with congenital cardiac malformation increases the risk of mortality in children with cardiac surgery on cardiopulmonary bypass. Recognition of a persistent LSVC and its associated anomalies is mandatory to avoid complications during or after cardiac surgery.
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MESH Headings
- Adolescent
- Cardiac Output, Low/diagnosis
- Cardiac Output, Low/epidemiology
- Cardiac Output, Low/etiology
- Cardiac Surgical Procedures/adverse effects
- Cardiac Surgical Procedures/methods
- Cardiac Surgical Procedures/mortality
- Cardiopulmonary Bypass/adverse effects
- Cardiopulmonary Bypass/methods
- Cardiopulmonary Bypass/mortality
- Child, Preschool
- Coronary Sinus/abnormalities
- Coronary Sinus/physiopathology
- Echocardiography
- Female
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/physiopathology
- Heart Defects, Congenital/surgery
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/etiology
- Infant, Newborn
- Male
- Mortality
- Outcome Assessment, Health Care
- Postoperative Complications/diagnosis
- Postoperative Complications/epidemiology
- Retrospective Studies
- Risk Assessment
- Switzerland/epidemiology
- Vascular Malformations/diagnosis
- Vascular Malformations/epidemiology
- Vascular Malformations/physiopathology
- Vascular Malformations/surgery
- Vena Cava, Superior/abnormalities
- Vena Cava, Superior/physiopathology
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Affiliation(s)
- Cristina Giuliani-Poncini
- Pediatric Intensive Care Unit, University Hospital Center and University of Lausanne, Lausanne, Switzerland
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Chinawa JM, Eze JC, Obi I, Arodiwe I, Ujunwa F, Daberechi AK, Obu HA. Synopsis of congenital cardiac disease among children attending University of Nigeria Teaching Hospital Ituku Ozalla, Enugu. BMC Res Notes 2013; 6:475. [PMID: 24252233 PMCID: PMC3843576 DOI: 10.1186/1756-0500-6-475] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 10/23/2013] [Indexed: 11/21/2022] Open
Abstract
Background The objective of this study was to determine the pattern of congenital cardiac disease among children attending UNTH, Enugu, Nigeria. The nature of these abnormalities and the outcome were also considered. The exact etiology is unknown but genetic and environmental factors tend to be implicated. The difference in the pattern obtained worldwide and few studies in Nigeria could be due to genetic, environmental, socioeconomic, or ethnic origin. Methods A retrospective analysis of discharged cases in which a review of the cases of all children attending children outpatient clinics including cardiology clinic of the University of Nigeria Teaching Hospital (UNTH), Enugu over a five year period (January 2007-June 2012) was undertaken. All the children presenting with cardiac anomalies were included in the study and the cases were investigated using ECG, X-ray and echocardiography studies. Results A total of 31,795 children attended the children outpatient clinics of the hospital over the study period. Of these, seventy one (71) had cardiac diseases. The overall prevalence of cardiac disease is 0.22%. The commonest symptoms were breathlessness, failure to thrive and cyanosis. Almost all types of congenital detects were represented, the commonest being isolated ventricular septal detect (VSD), followed by tetralogy of Fallot. One of these cardiac anomalies presented with Downs’s syndrome and another with VACTERAL association. Conclusions The results of this study show that 0.22% per cent of children who attended UNTH in Enugu State had congenital cardiac abnormalities and the commonest forms seen were those with VSD.
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Affiliation(s)
- Josephat M Chinawa
- Department of Paediatrics, University of Nigeria/Teaching Hospital, Enugu, Nigeria.
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Raj V, Joshi S, Ho YC, Kilner PJ. Case report: Completely unroofed coronary sinus with a left superior vena cava draining into the left atrium studied by cardiovascular magnetic resonance. Indian J Radiol Imaging 2011; 20:215-7. [PMID: 21042449 PMCID: PMC2963748 DOI: 10.4103/0971-3026.69359] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
A persistent left superior vena cava (LSVC) draining through a dilated coronary sinus into the right atrium is a relatively common congenital cardiovascular anomaly. It is readily identified by cardiovascular magnetic resonance (CMR). However, a LSVC draining into the left atrium (LA) and associated with unroofing of the coronary sinus, with resulting interatrial communication, is rare and may have important clinical consequences. As with any large atrial septal defect, it can be associated with a higher than expected incidence of pulmonary arterial hypertension, systemic embolization, and brain abscesses. In this report, we present a case of a completely unroofed coronary sinus with a persistent LSVC draining directly into the LA and illustrate the role of CMR in the diagnosis and evaluation of such anomalies.
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Affiliation(s)
- Vimal Raj
- Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital and Imperial College, Sydney Street, SW3 6NP, London, United Kingdom
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Transcatheter diagnosis and intervention for iatrogenic right-to-left shunts decades after surgical repair of partial anomalous pulmonary veins and an atrial septal defect. Pediatr Cardiol 2009; 30:1150-3. [PMID: 19609596 DOI: 10.1007/s00246-009-9487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Accepted: 06/15/2009] [Indexed: 10/20/2022]
Abstract
A 57-year-old man presented with symptomatic right-to-left shunts decades after surgical closure of an atrial septal defect and partial anomalous pulmonary veins. Two sources of shunting were identified: a baffle leak from the right superior vena cava (RSVC) to the left atrium secondary to complete occlusion of the RSVC-to-right atrium connection and an acquired previously unpublished coronary sinus to the left atrial shunt secondary to inadvertent closure of the coronary sinus. The diagnosis and transcatheter management of these unusual right-to-left shunts are reported.
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