A hitherto unreported combination of pulmonary stenosis, single coronary artery anomaly, and coronary sinus to left atrial communication

Abstract

Background: We report a hitherto unreported combination of pulmonary stenosis, single coronary artery anomaly and coronary sinus to left atrial communication. Our case highlights the important value of coronary computed tomographic angiography and transthoracic echocardiography for the diagnosis of such anomalies and guidance for proper management.

Is it really a levoatrial cardinal vein?

“…The finding of a collateral venous channel between the coronary sinus and the left atrium, however, as reported in one of the recent cases in the journal, 3 now provides a good explanation for these findings. In the strictest sense, since such a collateral channel extends between the cavities of the left atrium and a systemic venous tributary, the channel can justifiably be considered as an example of a "levoatrial cardinal vein."…”

“…To produce a fenestration between the cavities of the left atrium and the coronary sinus, therefore, it is necessary to have a deficiency not only of the wall of the coronary sinus, but also the wall of the left atrium. The finding of a collateral venous channel between the coronary sinus and the left atrium, however, as reported in one of the recent cases in the journal, 3 now provides a good explanation for these findings. In the strictest sense, since such a collateral channel extends between the cavities of the left atrium and a systemic venous tributary, the channel can justifiably be considered as an example of a “levoatrial cardinal vein.” It is still appropriately described, nonetheless, as a pulmonary‐to‐systemic venous collateral channel.…”

“…In the first example, there was mitral atresia, and the collateral channel was recognized as providing overflow from the left atrium in the setting of an intact atrial septum 1 . In the second case, reported the next year, the ventriculo‐arterial connections were discordant, with aortic coarctation, but the significant finding was “an anomalous jugulopulmonary vein of extreme interest.” As the authors of the latter report explained, the vein in question had “no counterpart in comparative anatomy,” and “no case had been found in which the systemic veins are directly connected to the pulmonary ventricle.” 2 These descriptions, now nearly 100 years old, are pertinent to the rash of cases recently reported within the pages of the journal with the so‐called “levoatrial cardinal vein.” 3–7 This venous channel, identical to the cases discussed above, was brought to prominence by the writings of Edwards and his colleagues during the 1950s 8–10 . in reality, the vein is neither “levo,” nor “atrial,” nor “cardinal.” Despite these facts, it is almost certainly the title by which it will continue to be described.…”

“…2 These descriptions, now nearly 100 years old, are pertinent to the rash of cases recently reported within the pages of the journal with the so-called "levoatrial cardinal vein." [3][4][5][6][7] This venous channel, identical to the cases discussed above, was brought to prominence by the writings of Edwards and his colleagues during the 1950s. [8][9][10] in reality, the vein is neither "levo," nor "atrial," nor "cardinal."…”

A rare V-shaped course variant of the posterior right diagonal artery: a case description and literature analysis

“…Approximately 80% of congenital coronary artery anomalies are benign and clinically asymptomatic, while 20% are clinically significant (17,18). Identifying anomalies is significant in cases of interventions, including surgical or interventional revascularization.…”