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A 51 year old man with chest discomfort was diagnosed at echocardiography with atrial septal defect. A persistent left superior vena cava (PLSVC) was found incidentally during preoperative cardiac catheterisation. Direct injection of contrast media into the PLSVC (left) showed that it filled the coronary sinus (large arrowhead) then the coronary veins (small arrowheads), that the coronary sinus did not communicate with the right atrium, and that the coronary venous flow entered the right atrium by the PLSVC, the innominate vein, and the right superior vena cava. Three dimensional computed tomography (CT) (right) showed the small PLSVC (arrowheads), the diameter of which was 4 mm at the midportion, extending from the coronary sinus to the innominate vein (IV). Moderate enlargement of the right ventricle (RV) with a prominent pulmonary artery (PA) is shown (AA, ascending aorta; LV, left ventricle; ARSA, aberrant right subclavian artery). The patient underwent surgical treatment for closure of the atrial septal defect, during which right atrial ostial atresia of the coronary sinus was confirmed.
Thirty six cases of atresia of the coronary sinus ostium with PLSVC have been previously reported. However, to our knowledge, this is the first reported three dimensional CT image of a small PLSVC associated with atrial atresia of the coronary sinus.