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Updated: Nov 4, 2025

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
A case report of an elderly male with isolated coronary sinus atrial septal defect
Junko Okamoto1, Shinji Fukuhara1, Hideki Ozawa1
1Department of Thoracic and Cardiovascular Surgery, Osaka Medical College, 2-7 Daigaku-Machi, Takatsuki, Osaka 569-0801, Japan.
Insights
Isolated coronary sinus atrial septal defect (CSASD) is rare, especially in the elderly. Surgical repair of CSASD in an elderly patient with atrial flutter significantly improved dyspnea, highlighting the importance of recognizing this congenital heart disease.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Cardiac Surgery
Background:
- Isolated coronary sinus atrial septal defect (CSASD) is a rare congenital cardiac anomaly, accounting for less than 1% of all atrial septal defects.
- Elderly patients presenting with CSASD are uncommon and may be overlooked, potentially leading to delayed diagnosis and treatment.
Background:
Isolated coronary sinus atrial septal defect (CSASD) is a rare congenital cardiac anomaly, comprising <1% of atrial septal defects. Elderly patients with this anomaly are even more uncommon and sometimes overlooked.
Case Summary:
A 73-year-old man with a history of electrical defibrillation therapy for atrial flutter presented with worsening exertional dyspnoea. Cardiac examination revealed CSASD without persistent left superior vena cava, showing only moderate tricuspid regurgitation. Surgical repair of the defect and regurgitant valve improved symptoms dramatically.
Discussion:
Elderly patients with atrial arrhythmias might show uncommon presentations of congenital heart disease. Cardiologists should pay attention to enlarged right ventricle, pulmonary artery, and, in particular, enlarged coronary sinus. Direct closure with interrupted sutures secured with pledgets is effective in some case of terminal type of CSASD.
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