Surgical repair of unroofed coronary sinus with severe mitral regurgitation in an elderly patient.

An unroofed coronary sinus (URCS) is a rare anomaly that produces communication between the left atrium (LA) and the coronary sinus (CS), resulting in a left-to-right shunt. Due to the lack of symptoms and particular anatomical characteristics, this disease is difficult to diagnose, and prone to be overlooked. An 85-year-old man was admitted to our hospital because of anorexia and shortness of breath. On physical examination, a systolic murmur was heard at the apex, and pitting edema was present in both legs. Transthoracic echocardiography showed severe regurgitation of the mitral valve and tricuspid valve. Transesophageal echocardiography confirmed a shunt between the LA and the CS. Because of uncontrolled heart failure, we performed surgical repair 50 days after admission. Under cardiopulmonary bypass and heart arrest, the URCS was detected in the LA and directly sutured. Repair of the mitral and tricuspid valves and the Maze procedure were also performed. The patient had a good postoperative course, and has been doing well for 2 years. Transesophageal echocardiography is helpful for diagnosis of URCS. Mitral regurgitation might raise the left atrial pressure and result in increase in shunt flow, causing left and right heart failure in elderly patients. <Learning objective: Diagnosis of an unroofed coronary sinus (URCS) is often overlooked in adult patients because of the lack of symptoms and/or particular anatomical characteristics. We herein describe an octogenarian patient who was diagnosed with URCS in association with severe mitral and tricuspid regurgitation. Transesophageal echocardiography helped to identify the location of the URCS. The cause of the heart failure was mitral regurgitation, which raised the left atrial pressure and increased shunt flow.>.