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[A case report of unroofed coronary sinus with repeated congestive cardiac failure]
N Takahashi1, S Sato, Y Kikuchi
1Department of Thoracic Surgery, Obihiro Hospital National Sanatorium, Japan.
Insights
A rare cardiac anomaly, unroofed coronary sinus, can cause heart failure and tricuspid regurgitation. Surgical repair is effective, but careful monitoring for left ventricular failure is crucial post-operation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Unroofed coronary sinus is a rare congenital anomaly.
- It can lead to significant cardiac complications, including heart failure and tricuspid regurgitation.
- Surgical intervention is often necessary for symptomatic cases.
Observation:
- A 64-year-old woman presented with recurrent cardiac failure.
- The patient had an unroofed coronary sinus complicated by tricuspid regurgitation.
- Echocardiography was instrumental in diagnosing the condition.
Findings:
- The patient underwent direct suture closure of the unroofed coronary sinus and tricuspid annuloplasty.
- Postoperatively, acute left ventricular failure occurred due to reduced left ventricular volume from the shunt.
- The patient recovered with medical management including catecholamines, digitalization, and diuretics.
Implications:
- Direct suture closure of unroofed coronary sinus is a viable surgical option.
- Postoperative left ventricular failure is a potential complication requiring vigilant management.
- Echocardiography is a key diagnostic tool for unroofed coronary sinus, particularly when associated with tricuspid regurgitation.
Abstract:
We reported a 64-year-old woman with frequent cardiac failure due to unroofed coronary sinus complicated with tricuspid regurgitation (TR). We performed direct suture closure of unroofed coronary sinus and tricuspid annuloplasty with a Carpentier ring (34 T). Immediately after the operation, large amount of pleural effusion accumulated owing to acute left ventricular failure. That cause consists in the scarcity of the left ventricular volume, which was depending on the much left-to-right shunt volume through the unroofed coronary sinus. But her general condition was recovered from acute left ventricular failure for administration of catecholamine, digitalization, and urinative. We think that the echocardiography is valuable to investigation of the existence of unroofed coronary sinus, especially complicated with TR.