Midterm follow‐up results of transcatheter treatment in patients with unroofed coronary sinus

Abstract

We present the midterm results of transcatheter treatment of unroofed coronary sinus (CS) using the Amplatzer septal occluder. The unroofed CS is a rare atrial septal defect communicating the left atrium and CS. Surgery has been the mainstay of treatment. In a 4.5-year period, nine patients (five males) with ages ranging from 26 to 69 years (median 39 years) diagnosed with an unroofed CS but without a persistent left superior vena cava (LSVC) underwent transcatheter treatment. Computerized tomography (CT) was performed in eight patients. Transesophageal echocardiography (TEE) was used to monitor the procedure. The mean Qp/Qs ratio was 2.4 ± 1 and mean systolic pulmonary artery pressure was 35 ± 19 mm Hg. An Amplatzer septal occluder was deployed in all nine patients. The device was implanted in the defect in one patient and at the CS ostium in the other eight patients. The median device size used was 22 mm (16-28 mm). The left disc herniated into the CS in the single patient in whom the device was implanted within the defect. All patients were available for the 3-month follow-up. None had a residual shunt on the 3-month follow-up echocardiography. One patient died of a stroke 4.5 months after the procedure. At mean follow-up of 42.6 ± 18.3 months, symptomatic improvement was documented in the remaining eight patients. All eight patients had an O₂ saturation above 96%. Transcatheter treatment for unroofed CS without persistent LSVC using Amplatzer septal occluder is safe and feasible.