PMC5353436_01
(a) Echocardiogram, parasternal long axis view. Dilated coronary sinus is demonstrated (arrow), along with descending Aorta (head arrow). Long and short axes of CS are shown. (b) Modified parasternal short axis. CS (arrow) and PLSVC (head arrow) are shown. (c) Modified four chamber view. Cs (arrow) is seen entering RA (star), postero superiorly to left ventricle (triangle)
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F1
The echocardiogram showed markedly dilated coronary sinus (CS): 30 mm x 17 mm (n.v: <15 mm), cross sectional area 3,2 cm2 and a confluent large vessel [Figure 1a, b and c] and, along with mildly altered septal movement related to conduction disturbance, mildly enlarged left atrium (42 mm parasternal long axis), mild ejection fraction (EF) reduction (51%) along with altered diastolic pattern (grade 1 diastolic dysfunction).
(a) CMR, cine sequence, vertical long axis (equivalent to apical two chamber echographic view), diastolic frame. The dilated CS (arrow) is shown. 1 left atrium (LA), 2 left ventricle (LV), 3 main pulmonary artery, 4 aortic arch. (b) axial view (similar to Figure 1c). CS (arrow) is seen entering RA (star), postero superiorly to left ventricle (triangle); inferior vena cava inlet in RA is shown (point arrow)
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F2
Cine sequences [Figures 2 and 3] showed absence of right superior vena cava and right and left innominate veins confluence in a left superior vena cava draining into a very dilated CS (major and minor axis: 26 and 18 mm (n.v.:<15 mm) normally connected to right atrium.
CMR, cine sequence, coronal view, diastolic frame. Slice width 8 mm. Arrow points to the site where superior vena cava, if present, should be seen entering upper RA. PLSVC is seen forming the left mediastinal border and draining into the very dilated CS, in turn connecting to RA. 1 PLSVC, 2 dilated CS, 3 RA, 4 LA, 5 ascending aorta, 6 left pulmonary artery, 7 right innominate vein and overlapping innominate artery and common carotid artery, 8 left innominate vein, 9 inferior vena cava
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F3
Cine sequences [Figures 2 and 3] showed absence of right superior vena cava and right and left innominate veins confluence in a left superior vena cava draining into a very dilated CS (major and minor axis: 26 and 18 mm (n.v.:<15 mm) normally connected to right atrium.