Spontaneous rupture of the dissected coronary sinus mimicking acute coronary syndrome Thomas Bartel, MD, Alfred Kocher, MD, Gudrun Feuchtner, MD, Silvana.

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Presentation transcript:

Spontaneous rupture of the dissected coronary sinus mimicking acute coronary syndrome Thomas Bartel, MD, Alfred Kocher, MD, Gudrun Feuchtner, MD, Silvana Müller, MD, Johannes O. Bonatti, MD, Bernhard Metzler, MD The Journal of Thoracic and Cardiovascular Surgery Volume 137, Issue 1, Pages e1-e3 (January 2009) DOI: 10.1016/j.jtcvs.2008.02.036 Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A and B, Enlarged and dissected coronary sinus (A) with turbulent fistular flow (B). 1, Turbulent entrance flow from the coronary sinus into the right atrium; CS, coronary sinus; IVC, inferior vena cava; PE, pericardial effusion; RA, right atrium. C and D, Computed tomographic 3-dimensional view of the heart by using a volume-rendering technique: giant left main coronary aneurysm (anterior view of the heart; C) from which an enlarged, heavily calcified circumflex artery originates, which drains distally into the dilated, septated coronary sinus (posterior view of the heart; D). A, Aneurysm; CS, coronary sinus; CX, circumflex coronary artery; LV, left ventricle; V, dilated posterolateral cardiac vein; 1, the fistula between circumflex coronary artery and coronary sinus. E and F, Computed tomographic axial oblique (E) and coronal oblique (F) planes of the heart. The circumflex artery drains into the dissected coronary sinus (E). The distal posterolateral vein is enlarged and shows thrombus formation and surrounding hemorrhage indicative of a concealed perforation (F). LV, left ventricle; CS, coronary sinus; CX, circumflex coronary artery; V, distal posterolateral vein; P, pericardium; X, hemorrhage; LA, left atrium; RV, right ventricle; 1, the circumflex artery drains into the dissected coronary sinus; 2, thrombus formation in the posterolateral vein. The Journal of Thoracic and Cardiovascular Surgery 2009 137, e1-e3DOI: (10.1016/j.jtcvs.2008.02.036) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Intraoperative view of the junction between the left main coronary aneurysm and the ectatic circumflex artery (A) and the circumflex artery to the coronary sinus fistula (B). A, Left main aneurysm; CS, coronary sinus; CX, circumflex artery; DX, first diagonal coronary artery; PDA, posterior descending coronary artery. The Journal of Thoracic and Cardiovascular Surgery 2009 137, e1-e3DOI: (10.1016/j.jtcvs.2008.02.036) Copyright © 2009 The American Association for Thoracic Surgery Terms and Conditions