Introduction
Unroofed coronary sinus (UCS) is an infrequent congenital cardiac anomaly, in which partial or complete deficiency of the roof of the coronary sinus might result in a communication between right and left atriums. Although imaging plays a fundamental role in the diagnosis of UCS, it might be difficult to diagnose with transthoracic echocardiography, because of its limited ability in evaluation of posterior structures of the heart.
Case Report
A 21-year old man presented to our cardiology clinic with a shortness of breath and mild exercise intolerance. His past medical history was unremarkable. His physical examination was within normal limits and ECG was unremarkable. He was referred for an echocardiographic evaluation and transthoracic echocardiography showed dilated right heart chambers, mildly dilated pulmonary artery, pulmonary artery systolic pressure of 45 mmHg, and Qp/Qs ratio was more than 1.5. However, we did not observe any defect on IAS or IVS. We performed an agitated saline study by injection into patient’s left antecubital vein, and bubbles were not seen in the coronary sinus or the left cardiac chambers, and persistent left sided superior vena cava (LSVC) was excluded. Interestingly, during agitated saline study, we detected a negative right atrial echo contrast effect as an indicator of left-to-right shunt. To confirm the diagnosis, the patient had a transesophageal echocardiography that showed no atrial or ventricular septal defect, and all pulmonary veins were drained normally. We observed a negative right atrial echo contrast effect, even though we did not show any ASD, VSD or abnormal pulmonary venous drainage. We suspected that the patient would be UCS. Afterwards, a multi detector CT (MDCT) was performed and revealed an abnormal communication between the base of the left atrium and the roof of the coronary sinus, consistent with an UCS. There was no suggestion of persistent LSVC. In our case report, the patient’s symptoms were not severe, he was managed conservatively and annual echocardiographic screening was recommended.
Case Report
A 21-year old man presented to our cardiology clinic with a shortness of breath and mild exercise intolerance. His past medical history was unremarkable. His physical examination was within normal limits and ECG was unremarkable. He was referred for an echocardiographic evaluation and transthoracic echocardiography showed dilated right heart chambers, mildly dilated pulmonary artery, pulmonary artery systolic pressure of 45 mmHg, and Qp/Qs ratio was more than 1.5. However, we did not observe any defect on IAS or IVS. We performed an agitated saline study by injection into patient’s left antecubital vein, and bubbles were not seen in the coronary sinus or the left cardiac chambers, and persistent left sided superior vena cava (LSVC) was excluded. Interestingly, during agitated saline study, we detected a negative right atrial echo contrast effect as an indicator of left-to-right shunt. To confirm the diagnosis, the patient had a transesophageal echocardiography that showed no atrial or ventricular septal defect, and all pulmonary veins were drained normally. We observed a negative right atrial echo contrast effect, even though we did not show any ASD, VSD or abnormal pulmonary venous drainage. We suspected that the patient would be UCS. Afterwards, a multi detector CT (MDCT) was performed and revealed an abnormal communication between the base of the left atrium and the roof of the coronary sinus, consistent with an UCS. There was no suggestion of persistent LSVC. In our case report, the patient’s symptoms were not severe, he was managed conservatively and annual echocardiographic screening was recommended.
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