A Baffling Atrial Septal Defect Repair
Image Modality: Illustration Table Figure
An unroofed coronary sinus (CS) variant of an atrial septal defect (ASD) is the least common type of ASD and involves an absent rim of tissue between the CS and the floor of the left atrium. It is associated with a persistent left superior vena cava. With a significant shunt, volume overload of the right-sided cardiac chambers may lead to right-sided chamber dilation. In the setting of an unroofed CS, agitated saline contrast injected in the left upper extremity typically demonstrates bubbles initially in the left atrium, indicating an unroofed CS. Subsequently, bubbles are seen in the right atrium due to the presence of a left-to-right shunt. In this case, agitated saline contrast is noted only in the left-sided cardiac chambers, indicating that there has been closure of the drainage of the CS into the right atrium, which is an unusual repair for CS ASD. Cardiac magnetic resonance imaging can complement echocardiographic imaging to demonstrate the left superior vena cava and any possible anomalous pulmonary venous drainage.
Date: May 29, 2020
Keywords: Diagnostic Imaging, Cardiac Imaging Techniques, Heart Defects, Congenital, Heart Septal Defects, Vena Cava, Superior, Echocardiography