Unroofed Coronary Sinus as Potential Cause of Ischemic Stroke Following Left Atrial Appendage Closure

Area of Science:

• Cardiology
• Vascular Neurology
• Medical Diagnostics

Background:

• Unroofed coronary sinus (UCS) is a rare congenital heart defect, often associated with persistent left superior vena cava (PLSVC).
• Atrial septal defects can lead to paradoxical embolism, causing strokes.
• Left atrial appendage closure is a common procedure for stroke prevention in atrial fibrillation.

Observation:

• A patient presented with recurrent embolic strokes after undergoing left atrial appendage closure for atrial fibrillation.
• Diagnostic imaging revealed an unroofed coronary sinus and a persistent left superior vena cava.

Findings:

• The unroofed coronary sinus, in conjunction with the persistent left superior vena cava, created a pathway for venous thromboembolism to enter the systemic circulation.
• This anatomical anomaly was identified as the underlying cause of the patient's recurrent embolic strokes.

Implications:

• Highlights the importance of considering intracardiac shunts, such as UCS with PLSVC, in patients with cryptogenic strokes, especially post-cardiac procedures.
• Suggests that thorough pre-procedural screening for complex congenital heart anomalies may be warranted in select patient populations.
• Underscores the need for a comprehensive diagnostic approach to recurrent embolic events following interventions for atrial fibrillation.