Babapoor-Farrokhran Savalan, Kalla Aditi, Bozorgnia Behnam, Amanullah Aman
Division of Cardiology, Department of Medicine, Albert Einstein Medical Center, 5501 Old York Road Unit 3, Philadelphia, PA 19141, USA.
Sidney Kimmel Medical College, Thomas Jefferson University, 1025 Walnut St #100, Philadelphia, PA 19107, USA.
Eur Heart J Case Rep. 2020 Dec 7;4(6):1-6. doi: 10.1093/ehjcr/ytaa421. eCollection 2020 Dec.
Unroofed coronary sinus (UCS) is a rare congenital cardiac anomaly in which there is complete or partial absence of the roof of the coronary sinus (CS) resulting in a communication between the right and left atria. There are four types of UCS described in the literature. While usually asymptomatic and discovered incidentally on imaging, UCS can be the source of a brain abscess or paradoxical embolism.
A 62-year-old gentleman presented to the emergency department with sudden onset of right-sided weakness and subsequent unresponsiveness. His brain computed tomography (CT) was consistent with left-sided stroke. Transthoracic echocardiography was remarkable for a dilated CS and an agitated saline study was suggestive of an UCS. A gated cardiac CT with coronary angiography confirmed a wide communication between the CS and left atrium. Right heart catheterization did not show evidence of left to right shunt. He had no abnormal rhythm on telemetry monitoring throughout his hospital stay.
Unroofed coronary sinus is the least prevalent form of an atrial septal defect. Unroofed coronary sinus is usually asymptomatic and is diagnosed incidentally in imaging studies, however, it should be suspected in patients with cerebral emboli or evidence of left to right shunt with unexplained arterial desaturation. Transthoracic echocardiography is the most widely used imaging modality for the diagnosis of UCS but is limited in its ability to visualize the posterior cardiac structures such as the CS and pulmonary veins. Gated cardiac CT is a great diagnostic tool for UCS.
无顶冠状静脉窦（UCS）是一种罕见的先天性心脏异常，其中冠状静脉窦（CS）的顶部完全或部分缺失，导致左右心房之间存在交通。文献中描述了四种类型的UCS。虽然UCS通常无症状，在影像学检查时偶然发现，但它可能是脑脓肿或反常栓塞的来源。
一名62岁男性因突发右侧肢体无力及随后的无反应状态被送往急诊科。他的脑部计算机断层扫描（CT）与左侧中风相符。经胸超声心动图显示CS扩张，盐水激发试验提示存在UCS。门控心脏CT冠状动脉造影证实CS与左心房之间存在广泛交通。右心导管检查未显示左向右分流的证据。他在住院期间的遥测监测中未出现异常心律。
无顶冠状静脉窦是房间隔缺损最不常见的形式。无顶冠状静脉窦通常无症状，在影像学研究中偶然诊断，但对于有脑栓塞或有左向右分流证据且伴有无法解释的动脉血氧饱和度降低的患者应怀疑此病。经胸超声心动图是诊断UCS最广泛使用的影像学检查方法，但在显示诸如CS和肺静脉等心脏后部结构方面能力有限。门控心脏CT是诊断UCS的一种很好的工具。
