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Image in Cardiology
Coronary sinus atrial septal defect in a 65-year-old woman: Diagnosis by two- and three-dimensional echocardiography
Comunicação interauricular do tipo seio coronário em mulher de 65 anos: diagnóstico por ecocardiografia 2D e 3D
Rafael De la Espriella-Juan
Corresponding author
rdelaespriella@gmail.com

Corresponding author.
, Rafael Payá-Serrano, Andrés Cubillos-Arango, Bruno Bochard-Villanueva, Sergio Sánchez-Álvarez, Salvador Morell-Cabedo
Consorcio Hospital Universitario de Valencia, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary sinus &#40;CS&#41; atrial septal defect &#40;ASD&#41; is a very uncommon anomaly &#40;accounting for &#60;1&#37; of all ASDs&#41; 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&#46; CS dilatation of a different extent caused by an interatrial shunt is an important clue to the diagnosis&#44; after other causes of the dilatation&#44; such as elevated right atrial pressure&#44; persistent left superior vena cava &#40;PLSVC&#41;&#44; and&#47;or coronary artery fistula to the CS have been excluded&#46;</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&#44; even light activity&#44; due to symptoms&#46; Vital signs were normal and physical examination revealed mild ankle edema at the time of presentation&#46; The ECG showed sinus rhythm with right bundle branch block as the only remarkable finding&#46; Transthoracic echocardiography revealed biatrial and right ventricular enlargement with elevated systolic pulmonary pressure &#40;60-65 mmHg&#41; and preserved biventricular systolic function&#46; Of note&#44; CS dilatation was observed in 4-chamber view &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Agitated saline was injected through a peripheral left brachial vein during the Valsalva maneuver&#44; but no right-to-left shunt or CS contrast enhancement was detected &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46; The injection was made through the left arm to exclude PLSVC&#46; Transesophageal echocardiography showed CS drainage below the inferior vena cava in mid-esophageal bicaval view &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>C&#41; and in cross-sectional 2-chamber view a posteromedial left atrial wall defect communicating with the CS was detected &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>D&#41;&#46; Three-dimensional &#40;3D&#41; real-time acquisition confirmed a 29 mm&#215;19 mm posteromedial left atrial wall defect communicating with the CS and draining into the right atrium&#44; establishing the diagnosis of CS atrial septal defect &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>E and F&#41;&#46;</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&#46; The combination of both imaging modalities &#40;transthoracic and 3D real-time transesophageal echocardiography&#41; may improve the diagnosis of this rare congenital heart defect&#46;</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&#46;</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&#46;</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&#46;</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&#46;</p></span></span>"
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Article information
ISSN: 21742049
Original language: English
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Revista Portuguesa de Cardiologia (English edition)
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