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Wide unroofed coronary sinus and cryptogenic stroke: a case report
Savalan Babapoor-Farrokhran1, Aditi Kalla1, Behnam Bozorgnia1,2
1Division of Cardiology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road Unit 3, Philadelphia, PA 19141, USA.
European Heart Journal. Case Reports
|February 25, 2021
Summary
Unroofed coronary sinus (UCS) is a rare congenital heart defect causing a communication between the atria. Gated cardiac CT is a valuable tool for diagnosing UCS, especially in patients with stroke or paradoxical embolism.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Medical Imaging
Background:
- Unroofed coronary sinus (UCS) is a rare congenital cardiac anomaly characterized by absence of the coronary sinus (CS) roof, creating an atrial communication.
- UCS can be asymptomatic and incidentally found, but may lead to serious complications like brain abscess or paradoxical embolism.
Purpose of the Study:
- To highlight the diagnostic utility of gated cardiac CT in a patient with suspected unroofed coronary sinus presenting with stroke.
Main Methods:
- Case presentation of a 62-year-old male with stroke symptoms.
- Diagnostic workup included brain CT, transthoracic echocardiography with agitated saline study, and gated cardiac CT with coronary angiography.
- Right heart catheterization and telemetry monitoring were also performed.
Main Results:
- Brain CT indicated a left-sided stroke.
- Echocardiography showed a dilated CS, and saline study suggested UCS.
- Gated cardiac CT confirmed a large communication between the CS and left atrium, with no significant left-to-right shunt detected.
Conclusions:
- Unroofed coronary sinus is a rare form of atrial septal defect, often diagnosed incidentally.
- UCS should be suspected in cases of cerebral emboli or unexplained arterial desaturation.
- While echocardiography is common, gated cardiac CT offers superior visualization for UCS diagnosis.
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