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Coronary sinus to left atrial communication.

Scheller V, Mazur W, Kong J, Chung ES - Case Rep Med (2009)

Bottom Line: We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia.In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation.In conclusion, further investigations revealed a communication between the coronary sinus (CS) and left atrium (LA).

View Article: PubMed Central - PubMed

Affiliation: Ohio Heart and Vascular Center, The Christ Hospital, Cincinnati, OH 45242, USA.

ABSTRACT
Congenital coronary sinus anomalies are rare in clinical practice, partly due to the lack of symptoms. We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia. In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation. In conclusion, further investigations revealed a communication between the coronary sinus (CS) and left atrium (LA).

No MeSH data available.


Related in: MedlinePlus

TEE showing doppler signal away from LA. The arrows indicate a dilated coronary sinus.
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fig2: TEE showing doppler signal away from LA. The arrows indicate a dilated coronary sinus.

Mentions: Her oxygen requirements were only 2-3 L/min by nasal cannula at baseline, to maintain oxygen saturation of 93%. To relieve discomfort due to her severe volume overload, and as the target volume was deemed to be in excess of 20 lbs, she was started on ultrafiltration using the Aquadex system (CHF Solutions, Inc.), with eventual removal of approximately 25 lbs of weight. With this degree of volume removal, it was noted that the patient's oxygen requirement appeared to increase to 8 L/minute oxygen via oximizer. A repeat transesophageal echocardiogram (TEE) was performed confirming the findings of the outlying hospital. Furthermore, on this study, a “ridge” at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an “unroofed” appearance, with apparent communication into the LA. (Figure 4).


Coronary sinus to left atrial communication.

Scheller V, Mazur W, Kong J, Chung ES - Case Rep Med (2009)

TEE showing doppler signal away from LA. The arrows indicate a dilated coronary sinus.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2734942&req=5

fig2: TEE showing doppler signal away from LA. The arrows indicate a dilated coronary sinus.
Mentions: Her oxygen requirements were only 2-3 L/min by nasal cannula at baseline, to maintain oxygen saturation of 93%. To relieve discomfort due to her severe volume overload, and as the target volume was deemed to be in excess of 20 lbs, she was started on ultrafiltration using the Aquadex system (CHF Solutions, Inc.), with eventual removal of approximately 25 lbs of weight. With this degree of volume removal, it was noted that the patient's oxygen requirement appeared to increase to 8 L/minute oxygen via oximizer. A repeat transesophageal echocardiogram (TEE) was performed confirming the findings of the outlying hospital. Furthermore, on this study, a “ridge” at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an “unroofed” appearance, with apparent communication into the LA. (Figure 4).

Bottom Line: We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia.In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation.In conclusion, further investigations revealed a communication between the coronary sinus (CS) and left atrium (LA).

View Article: PubMed Central - PubMed

Affiliation: Ohio Heart and Vascular Center, The Christ Hospital, Cincinnati, OH 45242, USA.

ABSTRACT
Congenital coronary sinus anomalies are rare in clinical practice, partly due to the lack of symptoms. We present a case of coronary sinus anomaly causing a right-to-left intracardiac shunt in a 46 years/old African American female with a past medical history of obstructive sleep apnea, diabetes mellitus, hypertension, coronary artery disease, and ischemic cardiomyopathy who presented with hypoxia. In the months prior to her presentation, she had suffered an inferior myocardial infarction with right ventricular involvement, as well as resulting severe tricuspid regurgitation. In conclusion, further investigations revealed a communication between the coronary sinus (CS) and left atrium (LA).

No MeSH data available.


Related in: MedlinePlus