case_images: PMC2734942_01
case_images: TEE showing severe tricuspid regurgitation.
case_images: CRM2009-790715.001.jpg
case_images: PMC2734942_01_CRM2009-790715.001.jpg
case_images: fig1
case_images: Severe tricuspid regurgitation was described. (Figure 1) She was then transferred to The Christ Hospital, Cincinnati, Ohio, for further evaluation in the cardiac catheterization laboratory for a presumed occult atrial septal defect and possible percutaneous closure. 
case_images: TEE showing doppler signal away from LA. The arrows indicate a dilated coronary sinus.
case_images: CRM2009-790715.002.jpg
case_images: PMC2734942_01_CRM2009-790715.002.jpg
case_images: fig2
case_images: Furthermore, on this study, a "ridge" at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an "unroofed" appearance, with apparent communication into the LA. (Figure 4).
case_images: TEE. The left arrow indicates the interatrial septum, and the right arrow indicates the opening at the inferoposterior corner of the LA floor.
case_images: CRM2009-790715.003.jpg
case_images: PMC2734942_01_CRM2009-790715.003.jpg
case_images: fig3
case_images: Furthermore, on this study, a "ridge" at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an "unroofed" appearance, with apparent communication into the LA. (Figure 4).
case_images: Cardiac CTA. The arrows indicate the coronary sinus with a communicating vessel to the LA.
case_images: CRM2009-790715.004.jpg
case_images: PMC2734942_01_CRM2009-790715.004.jpg
case_images: fig4
case_images: Furthermore, on this study, a "ridge" at the inferior aspect of the interatrial septum was noted associated with a color Doppler signal away from the RA. (Figure 2) A 3-dimensional assessment of the LA suggested a small opening at the inferoposterior corner. (Figure 3) A cardiac CT angiogram demonstrated moderate cardiomegaly with a small pericardial effusion; however, a severely dilated coronary sinus was detected, possibly with an "unroofed" appearance, with apparent communication into the LA. (Figure 4).
case_images: Coronary Sinus Venogram demonstrating an enlarged CS with communicating vessel into LA.
case_images: CRM2009-790715.005.jpg
case_images: PMC2734942_01_CRM2009-790715.005.jpg
case_images: fig5
case_images: Direction of contrast flow was entirely from the RA to the LA (Figure 5).
case_images: PMC2734942_02