PMC5803963_01
Four chamber(a) view shows dilated right atrium and right ventricle, dilated coronary sinus. The terminal unroofing of the coronary sinus is demonstrated by arrow in the subxiphoid image, (b) RA-right atrium, LA-left atrium, CS-coronary sinus, RV-right ventricle, LV-left ventricle
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F1
There was an unroofing of the terminal portion of the coronary sinus, where the left atrial blood entered the dilated coronary sinus [Figure 1].
Volume rendered three-dimensional echo after cropping the anterior half of both atria shows the enlarged coronary sinus ostium, through which the terminal unroofing is seen (circle). The pulmonary veins drain in the posterior wall of LA. The atrial septum is intact. RA: Right atrium, LA: Left atrium, CS: Coronary sinus, IVC: Inferior vena cava, LUPV: Left upper pulmonary vein, RUPV: Right upper pulmonary vein, IAS: Interatrial septum
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F2
Three-dimensional echocardiogram confirmed a posteroinferior atrial wall defect in the region of the ostium of the coronary sinus [Figure 2], establishing the diagnosis of isolated coronary sinus atrial septal defect, which was surgically confirmed [Figure 3].
Surgical view after opening the right atrium below the right atrial appendage and cannulation of the SVC and IVC, demonstrates terminal unroofing of the coronary sinus shown by arrow after inferiorly stretching its CSO with a forceps. A sucker is passed through the PFO into the left atrium. CSO: Coronary sinus ostium, PFO: Patent foramen ovale, IVC: Inferior vena cava, SVC: Superior vena cava, RAA: Right atrial appendage
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F3
Three-dimensional echocardiogram confirmed a posteroinferior atrial wall defect in the region of the ostium of the coronary sinus [Figure 2], establishing the diagnosis of isolated coronary sinus atrial septal defect, which was surgically confirmed [Figure 3].