Unroofed Coronary Sinus: Multimodality Imaging of Geriatric Congenital Heart Disease

An 84-year-old woman with hypertension presented to our medical center with dyspnea and lower extremity edema. Electrocardiography demonstrated atrial fibrillation with a rapid ventricular response. Transthoracic echocardiography color Doppler showed abnormal flow in the region of the interatrial septum (Fig. 1A). Transesophageal echocardiography demonstrated a defect adjacent to the interatrial septum (Fig. 1B) with leftto-right flow (Fig. 1C). Follow-up gated, 320-multidetector contrast-enhanced cardiac CT showed an isolated unroofed coronary sinus (Fig. 1D, E, and F). Three-dimensional volume-rendered cardiac CT sequential cut planes further depicted a dilated, unroofed coronary sinus (Fig. 1G-J). To the best of our knowledge we report multimodality imaging findings in the oldest patient diagnosed with an unroofed coronary sinus atrial septal defect, the rarest atrial septal defect (< 1%) which accounts for 0.1% of all congenital heart pISSN 1975-4612 / eISSN 2005-9655 Copyright © 2017 Korean Society of Echocardiography www.kse-jcu.org https://doi.org/10.4250/jcu.2017.25.2.72