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Percutaneous repair of unroofed coronary sinus with an atrial septal occluder

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PROVIDER: S-EPMC9897234 | biostudies-literature | 2023 Jan

REPOSITORIES: biostudies-literature

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Unroofed Coronary Sinus Atrial Septal Defect Misdiagnosed as Ostium Primum Defect.

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Case report: Robotic repair of unroofed coronary sinus.

Project description:Unroofed coronary sinus is a rare congenital heart disease caused by the partial or complete absence of the common wall between the coronary sinus and left atrium. When indicated for repair, it is done either percutaneously or surgically. Repair using a totally endoscopic robotic procedure is rarely performed nor reported in the literature. We report a case of a 47-year-old male who underwent a successful totally endoscopic robotic repair of this anomaly.

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Percutaneous repair of a sinotubular junction aortic pseudoaneurysm with an atrial septal defect occluder: a case report

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Totally endoscopic robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty.

Project description:BackgroundThe coronary sinus type of atrial septal defect is rare. Standard treatment typically involves intracardiac repair using conventional sternotomy or thoracotomy incisions; however, robotic technology can offer a feasible alternative due to its ability to provide a high-quality surgical view of this anomaly.Case presentationA 72-year-old man presented with asymptomatic atrial septal defect. Echocardiography revealed a direct communication between the left atrium and CS with left-to-right shunt flow and a Qp/Qs ratio of 2.1:1. The coronary sinus type of atrial septal defect was indicated for the totally endoscopic robotic repair considering few comorbidities. We present a successful robotic repair of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty via the right atrium, properly identifying the boundary between the mitral annulus and coronary sinus through a high-quality surgical view.ConclusionRobotic repair can serve as a viable and therapeutically effective alternative for cases of coronary sinus atrial septal defect with concomitant tricuspid annuloplasty.

| S-EPMC11533694 | biostudies-literature

Transesophageal echocardiography for coronary sinus imaging in partially unroofed coronary sinus.

Project description:BackgroundPartially unroofed coronary sinus (PUCS) is a rare congenital cardiac anomaly and prone to be misdiagnosed. The purpose of this study was to explore the value of transesophageal echocardiography (TEE) in CS imaging for the detection of PUCS and to develop a special two-dimensional TEE-based en face view of CS.MethodsTwenty adult patients with suspected PUCS, showing a dilated coronary sinus and an enlarged right heart on transthoracic echocardiography (TTE), underwent TEE examination. In the mid-esophageal plane and close to an angle of 120°, the en face view of the CS successfully imaged the roof of the CS, which was beyond the realm of the atrial septum, and the interatrial septum was obtained simultaneously in the same view. Meanwhile, the 3D zoom mode could clearly display the comprehensive volume image and the adjacent structures of the PUCS. The results of TEE were compared with the findings of surgery or catheterization.ResultsEn face view of the CS was obtained successfully by 2DTEE in 20 patients. In addition, 3DTEE was used for imaging of PUCS in 11 of the 20 patients. PUCS was ultimately confirmed in 13 patients either by surgery or catheterization. The TEE for PUCS diagnosis was consistent with the surgical findings.ConclusionTransesophageal echocardiography can be successfully applied to obtain the comprehensive view of CS and its surrounding structures. The en face view of CS provided by 2DTEE may be helpful in better understanding PUCS and discriminating it from associated atrial septal defects.

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Percutaneous closure of aortic pseudoaneurysm in a young female with atrial septal occluder.

Project description:This case report represents a novel technique for the treatment of a pseudoaneurysm of the aorta. Pseudoaneurysm of the aorta has been reported in patients post heart surgery. This case report is about a patient who had a pseudoaneurysm most probably following tuberculosis. Traditionally, the treatment of choice is surgical correction; however, in the current era, there are case reports describing the use of either stent grafts or Amplatzer occluders for occlusion of the pseudoaneurysm in high-risk surgical cases. We performed successful closure of the aortic pseudoaneurysm using atrial septal occluder. <Learning objective: Tuberculous arteritis can result in pseudoaneurysm rarely. Our patient had a large aneurysm compressing adjoining vital structures and was very high surgical risk case. This is the first case report of closure of tuberculous pseudoaneurysm by using atrial septal occluder in a young patient. In this case we have demonstrated that large pseudoaneurysms with narrow neck can be closed very safely using atrial septal occluder with immediate symptom relief and thrombosis of pseudoaneurysm at follow-up of three months.>.

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Huge thrombus formation 1 year after percutaneous closure of an atrial septal defect with an Amplatzer septal occluder.

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<b>Successful percutaneous occlusion of a large left circumflex coronary artery fistula draining into the coronary sinus using a</b> ventricular septal defect <b>occluder: a case report</b>.

Project description:BackgroundCoronary artery fistula (CAF) is a congenital anomaly of the coronaries that can lead to significant intracardiac shunting and myocardial ischaemia.Case summaryWe describe the case of a 15-year-old male with an incidentally documented precordial cardiac murmur. An evidently dilated coronary sinus (CS) on transthoracic echocardiography prompted further investigation. A computed tomography (CT) revealed the presence of a large CAF from the left circumflex coronary artery to the CS. No other structural heart defects were detected. A haemodynamically significant intracardiac shunt was confirmed during cardiac catheterization, and it was decided to close the fistula. This was successfully performed using a ventricular septal defect (VSD) occluder (Konar 10-8, Lifetech Scientific) that was deployed through a 6 Fr right coronary guiding catheter. A partial thrombotic occlusion of the CS behind the closure device was noted during follow-up which led to anticoagulation in a higher target INR range and concomitant start of low dose carbasalate calcium to reduce further retrograde thrombus extension. Patient is doing well at over 1 year of follow-up, and no further thrombotic extension into the CS was seen on a recent CT.DiscussionThis report illustrates the diagnostic workup and a percutaneous treatment strategy of a CAF using a VSD occluder. We also describe a not previously reported complication, thrombotic CS occlusion. Improving transcatheter techniques and marketing of novel devices with a broad spectrum of applications can offer new opportunities for treating CAF and avoiding surgical correction often involving cardiopulmonary bypass, reserving this option for patients with complex anatomy or failed transcatheter closure.

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