Khadkikar Gajanan, V Subrahmanya Murti, Patel Aman, Shah Sanjay C, Patel Tejas M
Cardiology, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND.
Interventional Cardiology, Apex Heart Institute, Ahmedabad, IND.
Cureus. 2021 Jan 31;13(1):e13041. doi: 10.7759/cureus.13041.
An unroofed coronary sinus is a rare congenital anomaly in the roof of the coronary sinus causing a communication between the coronary sinus and the left atrium leading to a left to right shunt. It is often associated with a persistent left superior vena cava and other complex congenital lesions like anomalous pulmonary venous return and heterotaxy. Since it is a deep-seated defect, it is seldom diagnosed by transthoracic two-dimensional (2D) echocardiography and requires multimodal imaging for a diagnosis. Here, we present the case of a 27-year-old male in whom the defect was very apparent on standard 2D transthoracic echocardiography. Transthoracic 2D echocardiography revealed situs solitus, levocardia, and a dilated coronary sinus with unroofing which was most prominent in the standard parasternal long-axis view and the foreshortened apical four-chamber view. A color Doppler demonstrated a flow from the left atrium into the dilated coronary sinus. The right ventricle and atrium were dilated with mild pulmonary arterial hypertension. There was no right ventricular dysfunction. Examination with modified suprasternal views showed a left superior vena cava. All four pulmonary veins drained into the left atrium. Other chambers of the heart and great vessels were structurally normal without coarctation or patent ductus arteriosus. The interventricular septum was intact and atrioventricular and ventriculoatrial concordance was preserved. Detection of a dilated coronary sinus by transthoracic 2D echocardiography must be followed by multimodal imaging techniques like cardiac computed tomography and transesophageal echocardiography to detect and manage associated defects.
冠状静脉窦未闭是一种罕见的先天性异常，位于冠状静脉窦顶部，导致冠状静脉窦与左心房之间形成交通，从而引起左向右分流。它常与永存左上腔静脉以及其他复杂的先天性病变相关，如肺静脉异位引流和内脏异位。由于它是一种深部缺陷，经胸二维（2D）超声心动图很少能诊断出来，需要多模态成像来进行诊断。在此，我们报告一例27岁男性病例，该缺陷在标准经胸2D超声心动图上非常明显。经胸2D超声心动图显示心脏位置正常、左位心，冠状静脉窦扩张且顶部未闭，在标准胸骨旁长轴视图和缩短的心尖四腔视图中最为明显。彩色多普勒显示有血流从左心房流入扩张的冠状静脉窦。右心室和右心房扩张，伴有轻度肺动脉高压。没有右心室功能障碍。经改良胸骨上凹视图检查显示有左上腔静脉。四条肺静脉均引流至左心房。心脏的其他腔室和大血管结构正常，无缩窄或动脉导管未闭。室间隔完整，房室和室房关系一致。经胸2D超声心动图检测到扩张的冠状静脉窦后，必须采用多模态成像技术，如心脏计算机断层扫描和经食管超声心动图，以检测和处理相关缺陷。
