Coronary sinus reconstruction - 2 cases report

Abstract

Introduction: Coronary sinus and ostium primum (unique atrium type) atrial septal defects (ASD) represent rare congenital malformations (less than 1% o f total ASDs) and are frequently associated with persistent left superior vena cava (LSVC). The shunt is caused in the first case by the incomplete development of the wall between the coronary sinus and the left atrium and in the second case, the coronary sinus drains into the single atrial cavity. Case description: Two patients (I. P., 15 years, B. G., 12 years) were operated in 2013 in our clinic. In the first case, although enlargement of the coronary sinus was not identified during echography, angio-CT showed fenestration of the coronary sinus wall and cardiac catheterization documented the bidirectional shunt as well as the persistent LSVC. Moreover, the ASD was associated with patent ductus arteriosis and cor triatriatum. In the second case the ostium primum ASD and the persistent LSVC as well as an anterior mitral valve cleft were diagnosed by echography and CT. Both patients underwent elective surgery. The coronaiy sinus was reconstructed in both cases using autologous pericardial patches. Moreover, in the first patient the ductus arteriosis was ligated and the intraatrial trabeculum was excised. In the second case the interatrial septum was reconstructed with autologous pericardium. Both cases had an unremarkable postoperatory recovery. Conclusions: Both cases showed that although the diagnosis for these malformations requires multiple investigations, a surgical correction with good long term results is feasible if the mechanism of the shunt is well documented.