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The coronary sinus interatrial connection with total unroofing coronary sinus discovered late after correction of secundum atrial septal defect
Author(s) -
Zieliński Piotr,
Kowalski Mirosław,
Kuśmierczyk Mariusz,
Hoffman Piotr,
Michałowska Ilona
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14990
Subject(s) - medicine , coronary sinus , septum secundum , interatrial septum , cardiology , persistent left superior vena cava , atrial fibrillation , shunt (medical) , surgery , left atrium
A coronary sinus (CS) interatrial connection is a rare congenital anomaly which can be in various types from atrial septal defect type unroofing CS to the total absence of the CS. The pathology usually accompanies the left superior caval vein (LSCV) draining to CS and in case of its absence directly to the left atrium (LA). We present a 53‐year‐old woman after surgical correction of a secundum atrial septal defect in 1974, with a CS interatrial connection and paroxysmal atrial fibrillation (PAF). She gave a history of PAF and was admitted to our clinic due to progressive exertional intolerance, peripheral edema, and mild hypoxia (SatO 2 92%) with subsequent cyanosis. Transthoracic echocardiography showed a left‐to‐right shunt in the posteroinferior part of the atrial septum. Computed tomography revealed a persistent LSCV draining directly into the LA, the absence of the CS, and cardiac veins draining into the LA. The right atrium (RA) and the LA were connected via a tunnel with a visible contrast passage from the left to the right side—the persisting mouth of the coronary sinus. The patient was qualified for surgical correction. A glutaraldehyde‐treated autologous pericardial patch was used to construct the tunnel connecting the LSVC and the RA. The second part of the patch was used to close the atrial communication at the inferior vena cava level. The patient had an uncomplicated postoperative course and is now classified in New York Heart Association Class II.