Unroofed Coronary Sinus Presenting as Cerebral Abscess: A Case Report

Area of Science:

• Cardiology
• Neurology
• Congenital Heart Disease

Background:

• Unroofed coronary sinus syndrome (URCS) is a rare congenital cardiac anomaly.
• Persistent left superior vena cava (PLSVC) is another rare congenital anomaly.
• These anomalies can lead to complex intracardiac shunting.

Observation:

• A 68-year-old woman with hypertension and congenital heart disease presented with speech difficulties and disorientation.
• Imaging revealed PLSVC with unroofed coronary sinus (URCS) and an atrial septal defect.
• She was diagnosed with a brain abscess, treated with antibiotics.

Findings:

• Cardiac catheterization confirmed a partially unroofed coronary sinus with a bidirectional shunt.
• The patient underwent surgical repair of URCS and the atrial septal defect.
• Following surgery, her dizziness resolved, and she reported increased energy.

Implications:

• URCS can present with unusual neurological symptoms like a brain abscess in late adulthood.
• Multimodality imaging and cardiac catheterization are crucial for diagnosis and management planning.
• Surgical or transcatheter repair of URCS offers an excellent prognosis for symptomatic patients.