Partially Unroofed Coronary Sinus
A 52-year-old man presented with moderate-effort dyspnea for 2 years, cardiomegaly on the chest radiograph, and atrial fibrillation on the ECG. The transthoracic echocardiography image was unclear because of obesity. Transesophageal echocardiography showed both atrial and right ventricular enlargement (Figure 1) and normal pulmonary venous return. An intact interatrial septum was found on the 4-chamber view of the transverse plane. A defect of the partial coronary sinus was found on the near longitudinal plane, and a significant left-to-right shunt was demonstrated by color Doppler flow imaging (Figure 1). With further rotation of the transducer, an intact interatrial septum and a defect beyond the realm of the atrial septum were obtained simultaneously in the same view (Figure 2). Diameter of the coronary sinus defect was 2.3 cm. The left superior vena cava was not confirmed by injection of agitated salt into the left median cubital vein. A coronary sinus defect may also be suggested by the catheter passing the coronary sinus through the left atrium and pulmonary vein. Selection angiography of the coronary sinus confirmed the communication between the coronary sinus and left atrium. Pulmonary artery pressure was 60/18 (mean 34) mm Hg. Pulmonary-to-systemic blood flow ratio was 1.68. The pulmonary vascular resistance was 3.2 Wood units. The patient was referred for surgical repair of the lesion.
The online-only Data Supplement, consisting of 3 Movies, is available with this article at http://circ.ahajournals.org/cgi/content/full/116/15/e373/DC1.