CTICasesOstial Atresia of the Coronary Sinus
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Imaging findings
Contrast-enhanced chest CT with left arm injection demonstrates a small persistent left superior vena cava (SVC) draining into a dilated coronary sinus. Gated imaging confirms that the coronary sinus has no communication with the right atrium (ostial atresia), resulting in retrograde contrast flow into the middle and great cardiac veins before eventually draining into the systemic venous system via a patent right SVC.
Key takeaways
Ostial atresia of the coronary sinus is a rare congenital anomaly in which the coronary sinus fails to open into the right atrium. Venous drainage of the myocardium is maintained through retrograde flow through a persistent left SVC. Recognizing this anomaly is critical prior to cardiothoracic surgery or electrophysiological procedures (such as pacemaker lead placement) to avoid severe venous congestion, myocardial infarction, or procedural failure.
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