Cardiac Stomach: A Giant Coronary Sinus with Persistent Left Superior Vena Cava and Severe Tricuspid Regurgitation

Abstract

A young patient with a history of congenital heart disease may harbor other undiscovered cardiac anomalies, whose consequences may surface many years later. After correction of the initial defect, if these patients present with further symptoms during chronic followup, they should be met with a high clinical index of suspicion and worked up for associated cardiac anomalies. In our case, a 39 year-old female with history of rheumatic heart disease, hypertension, diabetes, and hyperlipidemia presented with progressive dyspnea on exertion and lower extremity edema. Her past surgical history was notable for surgical repair of a congenital atrial septal defect (ASD) 17 years ago. On physical examination, she had a 3/6 holosystolic murmur along the left sternal border, as well as a soft diastolic murmur heard best at the apex. She had crackles in her lungs bilaterally. In addition, she exhibited elevated jugular venous pressure and 2+ pitting edema in her lower extremities bilaterally. Based on this presentation, she was diagnosed with congestive heart failure and admitted for further assessment and treatment.