CTICasesCoronary Sinus Atresia and LCx to Coronary Sinus Fistula with Persistent Left SVC
Imaging findings
Contrast-enhanced cardiac CT and MRI demonstrate a large aneurysm of the coronary sinus. The coronary sinus fails to drain into the right atrium due to atresia of its ostium at the Thebesian valve. A fistula is seen connecting the left circumflex artery to the coronary sinus, and venous outflow is achieved via a persistent left superior vena cava that drains retrogradely into the left brachiocephalic vein.
Key takeaways
Atresia of the coronary sinus ostium is a rare congenital anomaly. When associated with a coronary-to-coronary sinus fistula, the massive volume overload can lead to a giant aneurysm of the coronary sinus, which relies on persistent fetal collateral vessels (such as a left SVC) as a physiological 'pop-off' valve for venous drainage.
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