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Multidetector CT findings of a congenital coronary sinus anomaly: a report of two cases.

Chou MC, Wu MT, Chen CH, Lee MH, Tzeng WS - Korean J Radiol (2008)

Bottom Line: Congenital coronary sinus anomalies are extremely rare, and they have received relatively little attention.This is probably due to the lack of both clinical symptoms and significant cardiac functional disturbance.We present two cases of a coronary sinus anomaly and briefly review the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Yong-Kang Campus, Chi-Mei Medical Center, Taiwan, R.O.C.

ABSTRACT
Congenital coronary sinus anomalies are extremely rare, and they have received relatively little attention. This is probably due to the lack of both clinical symptoms and significant cardiac functional disturbance. We present two cases of a coronary sinus anomaly and briefly review the literature. Recognizing and being familiar with the variations of a congenital coronary sinus anomaly in congenital heart disease may avoid a misinterpretation of cardiac catheterization findings and the troublesome disruption of coronary sinus blood return during the surgical management of cardiac lesions.

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Coronary sinus anomaly with stenosis of right atrial ostium and coexisting levoatriocardinal vein communication to left atrium in 64-year-old woman.A. Dorsal view of reconstructed volume-rendered image reveals abnormal engorged coronary sinus (long white arrow) without grossly visible communication with right atrium (RA). There was engorged vascular channel (black star) arising from coronary sinus that was highly suggestive of communication with left atrium (LA).B. Maximum-intensity-projection image revealed that aforementioned vascular channel (black star) was connected to left atrium (LA) with large opening. Evidence of large left-to-right shunting is also noted according to equal high-contrast density within CS and LA. Stenostic end of coronary sinus into right atrium (RA) was also seen (black arrow).C. Sequential maximum-intensity-projection image next to B demonstrates stenostic right atrial ostium (black arrow) of coronary sinus. RA = right atrium, LA = left atriumD-G. Illustration of enlargement of coronary sinus (CS) associated with (D) a persistent left superior vena cava (PLSVC); (E) PLSVC and other anomalous systemic venous return; (F) anomalous left-to-right shunt from left atrium; (G) unusually large communication between left atrium and coronary sinus (modified from Mantini and colleagues (1)).H. Illustration of absence of coronary sinus, which is always associated with persistent left superior vena cava (PLSVC) and atrial septal defect (modified from Mantini and colleagues (1)).I. Illustration of hypoplasic coronary sinus; cardiac veins failed to join coronary sinus and emptied into atrial chamber through dilated thebesian channels (modified from Mantini and colleagues (1)).J. With functional persistent left superior vena cava (PLSVC), blood returns in retrograde direction, passing upward to persistent left superior vena cava (PLSVC), left innominate vein, right superior vena cava, and eventually into right atrium.K. Without persistent left superior vena cava (PLSVC), blood returns through levoatriocardinal vein then into left atrium (modified from Mantini and colleagues (1)).
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Figure 2: Coronary sinus anomaly with stenosis of right atrial ostium and coexisting levoatriocardinal vein communication to left atrium in 64-year-old woman.A. Dorsal view of reconstructed volume-rendered image reveals abnormal engorged coronary sinus (long white arrow) without grossly visible communication with right atrium (RA). There was engorged vascular channel (black star) arising from coronary sinus that was highly suggestive of communication with left atrium (LA).B. Maximum-intensity-projection image revealed that aforementioned vascular channel (black star) was connected to left atrium (LA) with large opening. Evidence of large left-to-right shunting is also noted according to equal high-contrast density within CS and LA. Stenostic end of coronary sinus into right atrium (RA) was also seen (black arrow).C. Sequential maximum-intensity-projection image next to B demonstrates stenostic right atrial ostium (black arrow) of coronary sinus. RA = right atrium, LA = left atriumD-G. Illustration of enlargement of coronary sinus (CS) associated with (D) a persistent left superior vena cava (PLSVC); (E) PLSVC and other anomalous systemic venous return; (F) anomalous left-to-right shunt from left atrium; (G) unusually large communication between left atrium and coronary sinus (modified from Mantini and colleagues (1)).H. Illustration of absence of coronary sinus, which is always associated with persistent left superior vena cava (PLSVC) and atrial septal defect (modified from Mantini and colleagues (1)).I. Illustration of hypoplasic coronary sinus; cardiac veins failed to join coronary sinus and emptied into atrial chamber through dilated thebesian channels (modified from Mantini and colleagues (1)).J. With functional persistent left superior vena cava (PLSVC), blood returns in retrograde direction, passing upward to persistent left superior vena cava (PLSVC), left innominate vein, right superior vena cava, and eventually into right atrium.K. Without persistent left superior vena cava (PLSVC), blood returns through levoatriocardinal vein then into left atrium (modified from Mantini and colleagues (1)).

Mentions: The MDCT findings revealed an abnormal engorged coronary sinus with stenosis of the right atrial ostium and coexisting abnormal tubular communication to the left atrium (Figs. 2A-C). Acceptable vascular lumens of the three major coronary arteries were found. Medical treatment was suggested, and the patient was tracked by outpatient follow-up. No other systemic venous anomaly was identified.


Multidetector CT findings of a congenital coronary sinus anomaly: a report of two cases.

Chou MC, Wu MT, Chen CH, Lee MH, Tzeng WS - Korean J Radiol (2008)

Coronary sinus anomaly with stenosis of right atrial ostium and coexisting levoatriocardinal vein communication to left atrium in 64-year-old woman.A. Dorsal view of reconstructed volume-rendered image reveals abnormal engorged coronary sinus (long white arrow) without grossly visible communication with right atrium (RA). There was engorged vascular channel (black star) arising from coronary sinus that was highly suggestive of communication with left atrium (LA).B. Maximum-intensity-projection image revealed that aforementioned vascular channel (black star) was connected to left atrium (LA) with large opening. Evidence of large left-to-right shunting is also noted according to equal high-contrast density within CS and LA. Stenostic end of coronary sinus into right atrium (RA) was also seen (black arrow).C. Sequential maximum-intensity-projection image next to B demonstrates stenostic right atrial ostium (black arrow) of coronary sinus. RA = right atrium, LA = left atriumD-G. Illustration of enlargement of coronary sinus (CS) associated with (D) a persistent left superior vena cava (PLSVC); (E) PLSVC and other anomalous systemic venous return; (F) anomalous left-to-right shunt from left atrium; (G) unusually large communication between left atrium and coronary sinus (modified from Mantini and colleagues (1)).H. Illustration of absence of coronary sinus, which is always associated with persistent left superior vena cava (PLSVC) and atrial septal defect (modified from Mantini and colleagues (1)).I. Illustration of hypoplasic coronary sinus; cardiac veins failed to join coronary sinus and emptied into atrial chamber through dilated thebesian channels (modified from Mantini and colleagues (1)).J. With functional persistent left superior vena cava (PLSVC), blood returns in retrograde direction, passing upward to persistent left superior vena cava (PLSVC), left innominate vein, right superior vena cava, and eventually into right atrium.K. Without persistent left superior vena cava (PLSVC), blood returns through levoatriocardinal vein then into left atrium (modified from Mantini and colleagues (1)).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627198&req=5

Figure 2: Coronary sinus anomaly with stenosis of right atrial ostium and coexisting levoatriocardinal vein communication to left atrium in 64-year-old woman.A. Dorsal view of reconstructed volume-rendered image reveals abnormal engorged coronary sinus (long white arrow) without grossly visible communication with right atrium (RA). There was engorged vascular channel (black star) arising from coronary sinus that was highly suggestive of communication with left atrium (LA).B. Maximum-intensity-projection image revealed that aforementioned vascular channel (black star) was connected to left atrium (LA) with large opening. Evidence of large left-to-right shunting is also noted according to equal high-contrast density within CS and LA. Stenostic end of coronary sinus into right atrium (RA) was also seen (black arrow).C. Sequential maximum-intensity-projection image next to B demonstrates stenostic right atrial ostium (black arrow) of coronary sinus. RA = right atrium, LA = left atriumD-G. Illustration of enlargement of coronary sinus (CS) associated with (D) a persistent left superior vena cava (PLSVC); (E) PLSVC and other anomalous systemic venous return; (F) anomalous left-to-right shunt from left atrium; (G) unusually large communication between left atrium and coronary sinus (modified from Mantini and colleagues (1)).H. Illustration of absence of coronary sinus, which is always associated with persistent left superior vena cava (PLSVC) and atrial septal defect (modified from Mantini and colleagues (1)).I. Illustration of hypoplasic coronary sinus; cardiac veins failed to join coronary sinus and emptied into atrial chamber through dilated thebesian channels (modified from Mantini and colleagues (1)).J. With functional persistent left superior vena cava (PLSVC), blood returns in retrograde direction, passing upward to persistent left superior vena cava (PLSVC), left innominate vein, right superior vena cava, and eventually into right atrium.K. Without persistent left superior vena cava (PLSVC), blood returns through levoatriocardinal vein then into left atrium (modified from Mantini and colleagues (1)).
Mentions: The MDCT findings revealed an abnormal engorged coronary sinus with stenosis of the right atrial ostium and coexisting abnormal tubular communication to the left atrium (Figs. 2A-C). Acceptable vascular lumens of the three major coronary arteries were found. Medical treatment was suggested, and the patient was tracked by outpatient follow-up. No other systemic venous anomaly was identified.

Bottom Line: Congenital coronary sinus anomalies are extremely rare, and they have received relatively little attention.This is probably due to the lack of both clinical symptoms and significant cardiac functional disturbance.We present two cases of a coronary sinus anomaly and briefly review the literature.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Yong-Kang Campus, Chi-Mei Medical Center, Taiwan, R.O.C.

ABSTRACT
Congenital coronary sinus anomalies are extremely rare, and they have received relatively little attention. This is probably due to the lack of both clinical symptoms and significant cardiac functional disturbance. We present two cases of a coronary sinus anomaly and briefly review the literature. Recognizing and being familiar with the variations of a congenital coronary sinus anomaly in congenital heart disease may avoid a misinterpretation of cardiac catheterization findings and the troublesome disruption of coronary sinus blood return during the surgical management of cardiac lesions.

Show MeSH
Related in: MedlinePlus