Pediatric Surgery for Unroofed Coronary Sinus Workup

Updated: Jan 04, 2016
  • Author: Sergey G Toshinskiy; Chief Editor: John Kupferschmid, MD  more...
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Workup

Imaging Studies

Echocardiography (3- or 2-dimensional) can reveal an unroofed coronary sinus (UCS) and/or persistent left superior vena cava (PLSVC). However, the diagnosis can be missed, even by those with experience, which can lead to a diagnosis made at the time of surgery. [5] Xie et al have estimated the diagnostic accuracy of transthoracic and contrast echocardiography for UCS at only 65%. [19] Injection of agitated saline into the left antecubital vein during echocardiography can confirm the diagnosis of a PLSVC. Bubbles are seen in the coronary sinus before appearing in the right heart. [7] Echocardiography findings can be inconclusive because deep structures such as the coronary sinus are not always well delineated.

When the echocardiography findings are inconclusive, further imaging may be necessary. Newer generations of multidetector CT (MDCT) scanners can offer 3-dimensional reconstructions of cardiac structures and require less time, making this imaging modality a favorable choice for uncooperative patients or pediatric patients. [13, 20] MDCT scanning has high spatial and temporal resolutions, multiplanar reconstruction capabilities, and a wide field of view, making it an excellent tool for the detection and characterization of defects and for the identification of associated anomalies of the heart and pulmonary vasculature. [21]

Cardiac MRI provides high contrast of the internal cardiac structures without the need for injection of contrast media. [11] ).

Cardiac catheterization can also confirm the presence of a PLSVC associated with an UCS atrial septal defect (ASD) via selective angiography of the systemic veins, coronary sinus, or left atrium. [5, 22]