PMC2734942_01
TEE showing severe tricuspid regurgitation.
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fig1
Severe tricuspid regurgitation was described. (Figure 1) She was then transferred to The Christ Hospital, Cincinnati, Ohio, for further evaluation in the cardiac catheterization laboratory for a presumed occult atrial septal defect and possible percutaneous closure. 
TEE showing doppler signal away from LA. The arrows indicate a dilated coronary sinus.
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fig2
Furthermore, on this study, a "ridge" at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an "unroofed" appearance, with apparent communication into the LA. (Figure 4).
TEE. The left arrow indicates the interatrial septum, and the right arrow indicates the opening at the inferoposterior corner of the LA floor.
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fig3
Furthermore, on this study, a "ridge" at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an "unroofed" appearance, with apparent communication into the LA. (Figure 4).
Cardiac CTA. The arrows indicate the coronary sinus with a communicating vessel to the LA.
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fig4
Furthermore, on this study, a "ridge" at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an "unroofed" appearance, with apparent communication into the LA. (Figure 4).
Coronary Sinus Venogram demonstrating an enlarged CS with communicating vessel into LA.
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fig5
Direction of contrast flow was entirely from the RA to the LA (Figure 5).
PMC2734942_02