Very rare. Coronary sinus anomaly often associated with persistence of the left superior vena cava (65 %) (see this term) and associated, in those patients, with a congenitalheart disease such as total abnormal pulmonary venous return, triatrial heart, Tetralogy of Fallot or atrioventricular canal.

The coronary sinus is a large vein draining the cardiac veins. It is located in the left atrioventricular sulcus. It flows into the right atrium between the tricuspid valve and the opening of the inferior vena cava, near an accessory pacemaker known as the coronary sinus node.

There are four types:

-        type I (52 %): absence of coronary sinus (or total fenestration) with drainage of the upper left vena cava in the L.A., presence of an ASD

-        type II (4 %): absence of coronary sinus (or total fenestration) and of a left superior vena cava, presence of an ASD

-        type III (9 %): fenestration of the coronary sinus at the posterior part of the L.A.; presence or absence of a left superior vena cava

-        type IV (30 %): opening of the coronary sinus at the posterior part of the LA with presence of an ASD; presence or absence of a superior vena cava

-        association of types III and IV (5 %).

It is a contributing factor for brain abscesses or even stroke due to the right-left shunt.

Diagnosis: echocardiography with rapid injection of an agitated saline solution (bubble contrast) from the left upper limb to detect the presence of an abnormal drainage in the LA, of a left superior vena cava and/or a fenestrated coronary sinus.

Anesthetic implications:

left to right shunt in the L.A.. To know before starting cardiac bypass.

References:

•        Niyogi SG, Mandal B, Dogra N, Mishra AK.
  Partial unroofed coronary sinus : an uncommon cause of postcardiac surgery hypoxemia.
  A&A Practice, 2020, in press

Updated: February 2020