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(B) agitated saline through a peripheral left brachial vein during the Valsalva maneuver; (C) mid-esophageal bicaval view with coronary sinus drainage below the inferior vena cava; (D) cross-sectional 2-chamber view showing a posteromedial left atrial wall defect communicating with the coronary sinus; (E and F) three-dimensional real-time TEE with the mitral valve (MV) as reference point and the left atrial wall defect marked with an asterisk.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary sinus (CS) atrial septal defect (ASD) is a very uncommon anomaly (accounting for <1% of all ASDs) that occurs as a result of a defect in the wall between the CS and the left atrium due to hypoplasia of the left atriovenous fold during embryonic development. CS dilatation of a different extent caused by an interatrial shunt is an important clue to the diagnosis, after other causes of the dilatation, such as elevated right atrial pressure, persistent left superior vena cava (PLSVC), and/or coronary artery fistula to the CS have been excluded.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 65-year-old woman with a previous history of paroxysmal atrial fibrillation was referred to our hospital for exertional dyspnea with marked limitation in her daily activity, even light activity, due to symptoms. Vital signs were normal and physical examination revealed mild ankle edema at the time of presentation. The ECG showed sinus rhythm with right bundle branch block as the only remarkable finding. Transthoracic echocardiography revealed biatrial and right ventricular enlargement with elevated systolic pulmonary pressure (60-65 mmHg) and preserved biventricular systolic function. Of note, CS dilatation was observed in 4-chamber view (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A). Agitated saline was injected through a peripheral left brachial vein during the Valsalva maneuver, but no right-to-left shunt or CS contrast enhancement was detected (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B). The injection was made through the left arm to exclude PLSVC. Transesophageal echocardiography showed CS drainage below the inferior vena cava in mid-esophageal bicaval view (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C) and in cross-sectional 2-chamber view a posteromedial left atrial wall defect communicating with the CS was detected (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D). Three-dimensional (3D) real-time acquisition confirmed a 29 mm×19 mm posteromedial left atrial wall defect communicating with the CS and draining into the right atrium, establishing the diagnosis of CS atrial septal defect (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E and F).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">3D real-time transesophageal echocardiography is a valuable tool for detailing the type of roof defect and for identifying abnormal positions of the CS ostium. The combination of both imaging modalities (transthoracic and 3D real-time transesophageal echocardiography) may improve the diagnosis of this rare congenital heart defect.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-01-08" "fechaAceptado" => "2016-02-20" "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1481 "Ancho" => 1802 "Tamanyo" => 259447 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Coronary sinus dilatation on transthoracic echocardiography (TTE), 4-chamber view; (B) agitated saline through a peripheral left brachial vein during the Valsalva maneuver; (C) mid-esophageal bicaval view with coronary sinus drainage below the inferior vena cava; (D) cross-sectional 2-chamber view showing a posteromedial left atrial wall defect communicating with the coronary sinus; (E and F) three-dimensional real-time TEE with the mitral valve (MV) as reference point and the left atrial wall defect marked with an asterisk.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003600000001/v1_201701200114/S217420491630277X/v1_201701200114/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003600000001/v1_201701200114/S217420491630277X/v1_201701200114/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217420491630277X?idApp=UINPBA00004E" ]
Year/Month | Html | Total | |
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2024 November | 9 | 5 | 14 |
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2024 September | 75 | 23 | 98 |
2024 August | 66 | 28 | 94 |
2024 July | 71 | 32 | 103 |
2024 June | 58 | 17 | 75 |
2024 May | 52 | 31 | 83 |
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2024 March | 77 | 34 | 111 |
2024 February | 56 | 26 | 82 |
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2023 December | 55 | 27 | 82 |
2023 November | 66 | 36 | 102 |
2023 October | 74 | 20 | 94 |
2023 September | 42 | 20 | 62 |
2023 August | 45 | 27 | 72 |
2023 July | 75 | 15 | 90 |
2023 June | 68 | 14 | 82 |
2023 May | 62 | 29 | 91 |
2023 April | 44 | 5 | 49 |
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2021 September | 24 | 24 | 48 |
2021 August | 29 | 29 | 58 |
2021 July | 26 | 28 | 54 |
2021 June | 14 | 23 | 37 |
2021 May | 29 | 39 | 68 |
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2021 February | 49 | 13 | 62 |
2021 January | 28 | 8 | 36 |
2020 December | 28 | 5 | 33 |
2020 November | 20 | 18 | 38 |
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2020 September | 47 | 12 | 59 |
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2020 June | 27 | 9 | 36 |
2020 May | 35 | 5 | 40 |
2020 April | 19 | 10 | 29 |
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2019 October | 25 | 5 | 30 |
2019 September | 14 | 10 | 24 |
2019 August | 25 | 2 | 27 |
2019 July | 29 | 10 | 39 |
2019 June | 27 | 12 | 39 |
2019 May | 25 | 16 | 41 |
2019 April | 14 | 14 | 28 |
2019 March | 10 | 13 | 23 |
2019 February | 19 | 6 | 25 |
2019 January | 15 | 6 | 21 |
2018 December | 16 | 14 | 30 |
2018 November | 17 | 11 | 28 |
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2018 August | 27 | 3 | 30 |
2018 July | 14 | 6 | 20 |
2018 June | 23 | 6 | 29 |
2018 May | 22 | 8 | 30 |
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2018 March | 36 | 4 | 40 |
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2018 January | 22 | 6 | 28 |
2017 December | 21 | 5 | 26 |
2017 November | 11 | 8 | 19 |
2017 October | 21 | 7 | 28 |
2017 September | 7 | 3 | 10 |
2017 August | 17 | 7 | 24 |
2017 July | 13 | 3 | 16 |
2017 June | 24 | 12 | 36 |
2017 May | 25 | 3 | 28 |
2017 April | 19 | 3 | 22 |
2017 March | 29 | 8 | 37 |
2017 February | 66 | 10 | 76 |
2017 January | 24 | 6 | 30 |