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Case report: Completely unroofed coronary sinus with a left superior vena cava draining into the left atrium studied by cardiovascular magnetic resonance.

Raj V, Joshi S, Ho YC, Kilner PJ - Indian J Radiol Imaging (2010)

Bottom Line: A persistent left superior vena cava (LSVC) draining through a dilated coronary sinus into the right atrium is a relatively common congenital cardiovascular anomaly.It is readily identified by cardiovascular magnetic resonance (CMR).In this report, we present a case of a completely unroofed coronary sinus with a persistent LSVC draining directly into the LA and illustrate the role of CMR in the diagnosis and evaluation of such anomalies.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital and Imperial College, Sydney Street, SW3 6NP, London, United Kingdom.

ABSTRACT
A persistent left superior vena cava (LSVC) draining through a dilated coronary sinus into the right atrium is a relatively common congenital cardiovascular anomaly. It is readily identified by cardiovascular magnetic resonance (CMR). However, a LSVC draining into the left atrium (LA) and associated with unroofing of the coronary sinus, with resulting interatrial communication, is rare and may have important clinical consequences. As with any large atrial septal defect, it can be associated with a higher than expected incidence of pulmonary arterial hypertension, systemic embolization, and brain abscesses. In this report, we present a case of a completely unroofed coronary sinus with a persistent LSVC draining directly into the LA and illustrate the role of CMR in the diagnosis and evaluation of such anomalies.

No MeSH data available.


Related in: MedlinePlus

(A) Four-chamber image of the patient shows absence of a dilated coronary coronary sinus (arrow) which, given the presence of the LSVC, would be expected to pass through this plane in the region of the arrow. The image also shows relative dilatation of the right atrium and right ventricle. (B) For comparison, the four-chamber image of another patient with a persistant LSVC shows a dilated coronary sinus (arrow) which drains into the right atrium. (C) For further comparison, four-chamber image of a healthy volunteer shows a normal-sized coronary sinus (arrow)
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Figure 0002: (A) Four-chamber image of the patient shows absence of a dilated coronary coronary sinus (arrow) which, given the presence of the LSVC, would be expected to pass through this plane in the region of the arrow. The image also shows relative dilatation of the right atrium and right ventricle. (B) For comparison, the four-chamber image of another patient with a persistant LSVC shows a dilated coronary sinus (arrow) which drains into the right atrium. (C) For further comparison, four-chamber image of a healthy volunteer shows a normal-sized coronary sinus (arrow)

Mentions: The images and velocity maps showed evidence of a completely unroofed coronary sinus. Given the fact that there was a left as well as a right SVC, visibility of its continuation into a dilated coronary sinus would have been expected in the three- or four-chamber long-axis cine images, but this was not the case [Figure 2]. Bidirectional flow through the associated interatrial communication, which was about 15 mm in diameter, was visible in the atrial short-axis cine images and the corresponding velocity acquisition [Figure 1D and E]. The through-plane velocity mapping measured 4.4 l/min in the pulmonary trunk and 6.9 l/min in the ascending aorta, indicative of a net right-to-left shunt with Qp : Qs = 0.6 : 1. The right ventricle was dilated and moderately hypertrophied, with a low ejection fraction of 25%, and there was systolic flattening of the interventricular septum. Biventricular volume measurements showed a larger left ventricular stroke volume than right ventricular stroke volume, which was in accordance with the presence of a right-to-left shunt. The pulmonary arteries were dilated (main PA = 41 mm) and showed limited systolic expansion on cine images. The combined findings were consistent with pulmonary arterial hypertension.Figure 2 (A-C)


Case report: Completely unroofed coronary sinus with a left superior vena cava draining into the left atrium studied by cardiovascular magnetic resonance.

Raj V, Joshi S, Ho YC, Kilner PJ - Indian J Radiol Imaging (2010)

(A) Four-chamber image of the patient shows absence of a dilated coronary coronary sinus (arrow) which, given the presence of the LSVC, would be expected to pass through this plane in the region of the arrow. The image also shows relative dilatation of the right atrium and right ventricle. (B) For comparison, the four-chamber image of another patient with a persistant LSVC shows a dilated coronary sinus (arrow) which drains into the right atrium. (C) For further comparison, four-chamber image of a healthy volunteer shows a normal-sized coronary sinus (arrow)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2963748&req=5

Figure 0002: (A) Four-chamber image of the patient shows absence of a dilated coronary coronary sinus (arrow) which, given the presence of the LSVC, would be expected to pass through this plane in the region of the arrow. The image also shows relative dilatation of the right atrium and right ventricle. (B) For comparison, the four-chamber image of another patient with a persistant LSVC shows a dilated coronary sinus (arrow) which drains into the right atrium. (C) For further comparison, four-chamber image of a healthy volunteer shows a normal-sized coronary sinus (arrow)
Mentions: The images and velocity maps showed evidence of a completely unroofed coronary sinus. Given the fact that there was a left as well as a right SVC, visibility of its continuation into a dilated coronary sinus would have been expected in the three- or four-chamber long-axis cine images, but this was not the case [Figure 2]. Bidirectional flow through the associated interatrial communication, which was about 15 mm in diameter, was visible in the atrial short-axis cine images and the corresponding velocity acquisition [Figure 1D and E]. The through-plane velocity mapping measured 4.4 l/min in the pulmonary trunk and 6.9 l/min in the ascending aorta, indicative of a net right-to-left shunt with Qp : Qs = 0.6 : 1. The right ventricle was dilated and moderately hypertrophied, with a low ejection fraction of 25%, and there was systolic flattening of the interventricular septum. Biventricular volume measurements showed a larger left ventricular stroke volume than right ventricular stroke volume, which was in accordance with the presence of a right-to-left shunt. The pulmonary arteries were dilated (main PA = 41 mm) and showed limited systolic expansion on cine images. The combined findings were consistent with pulmonary arterial hypertension.Figure 2 (A-C)

Bottom Line: A persistent left superior vena cava (LSVC) draining through a dilated coronary sinus into the right atrium is a relatively common congenital cardiovascular anomaly.It is readily identified by cardiovascular magnetic resonance (CMR).In this report, we present a case of a completely unroofed coronary sinus with a persistent LSVC draining directly into the LA and illustrate the role of CMR in the diagnosis and evaluation of such anomalies.

View Article: PubMed Central - PubMed

Affiliation: Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital and Imperial College, Sydney Street, SW3 6NP, London, United Kingdom.

ABSTRACT
A persistent left superior vena cava (LSVC) draining through a dilated coronary sinus into the right atrium is a relatively common congenital cardiovascular anomaly. It is readily identified by cardiovascular magnetic resonance (CMR). However, a LSVC draining into the left atrium (LA) and associated with unroofing of the coronary sinus, with resulting interatrial communication, is rare and may have important clinical consequences. As with any large atrial septal defect, it can be associated with a higher than expected incidence of pulmonary arterial hypertension, systemic embolization, and brain abscesses. In this report, we present a case of a completely unroofed coronary sinus with a persistent LSVC draining directly into the LA and illustrate the role of CMR in the diagnosis and evaluation of such anomalies.

No MeSH data available.


Related in: MedlinePlus