Unroofed Coronary Sinus in a Patient With Prior Surgical Closure of Secundum Atrial Septal Defect

Area of Science:

• Cardiology
• Congenital Heart Disease
• Medical Imaging

Background:

• Unroofed coronary sinus (UCS) is a rare congenital cardiac anomaly, accounting for less than 1% of all atrial septal defects (ASDs).
• UCS can lead to left-to-right shunting and poses a risk for paradoxical embolization, potentially causing neurological complications.
• Persistent left superior vena cava (PLSVC) is another congenital anomaly that can coexist with UCS.

Observation:

• A 40-year-old asymptomatic male with a history of surgically closed ostium secundum ASD was evaluated preoperatively for non-cardiac surgery.
• Transthoracic echocardiography initially suggested the presence of a UCS with PLSVC.
• Transesophageal echocardiography confirmed the diagnosis of unroofed coronary sinus with persistent left superior vena cava.

Findings:

• The study identified an unroofed coronary sinus in conjunction with a persistent left superior vena cava.
• Echocardiography, particularly transesophageal echocardiography, proved effective in diagnosing this uncommon congenital cardiac anomaly.
• The patient remained asymptomatic despite the presence of the cardiac defect.

Implications:

• Early detection of unroofed coronary sinus is crucial for preventing complications like paradoxical embolization.
• Echocardiography plays a vital role in diagnosing congenital cardiac anomalies, including UCS and PLSVC.
• This case underscores the importance of thorough preoperative cardiac evaluation, even in asymptomatic individuals with a history of cardiac surgery.