Coronary Sinus Atrial Septal Defect (Unroofed Coronary Sinus
Case Report
A 16-year old girl was referred for echocardiographic evaluation with a history of exertional dyspnea and recurrent episodes of respiratory infection from childhood. Her pulse rate was 88 bpm and blood pressure 110/70 mmHg. Physical examination revealed mild cyanosis and clubbing. Auscultation revealed grade 2/6 soft systolic murmur in the left second intercostal space with a wide, fixed splitting of second heart sound. Ultrasound abdomen revealed normal liver and spleen. Blood chemistry revealed normal. ECG revealed right axis deviation and right bundle branch block (RBBB) pattern as shown in Figure 1. X-ray chest revealed increased pulmonary vascular markings with peripheral extension and a central prominence suggesting a left-to-right shunt at atrial level as shown in Figure 2. Transthoracic 2D echocardiography revealed an unroofed coronary sinus draining into the left atrium with anomalous pulmonary venous connection and an associated ostium secundum atrial septal defect (ASD) as shown in Figures 3-14. The girl was treated with antibiotics for the respiratory infection and advised early surgical correction....