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J Thorac Cardiovasc Surg 2009;137:e1-e3
© 2009 The American Association for Thoracic Surgery

Brief Communication

Spontaneous rupture of the dissected coronary sinus mimicking acute coronary syndrome

Thomas Bartel, MDa,*, Alfred Kocher, MDb, Gudrun Feuchtner, MDc, Silvana Müller, MDa, Johannes O. Bonatti, MDc, Bernhard Metzler, MDa

a Cardiology Division, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
b Department of Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria
c Institute of Radiology, Medical University Innsbruck, Innsbruck, Austria

Received for publication February 6, 2008; revisions received February 6, 2008; accepted for publication February 17, 2008.

* Address for reprints: Thomas Bartel, MD, Cardiology Division, Department of Internal Medicine, University of Innsbruck, Anichstr. 35, A-6020 Innsbruck, Austria. (Email: thomas.bartel@i-med.ac.at).

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Coronary sinus (CS) dissection has been described as a complication of pacing electrode implantation only.1Go We report here the diagnosis and surgical therapy of spontaneous rupture of a dissected CS in a patient with acute coronary syndrome (ACS) and circumflex artery (CX) to the CS fistula.

Clinical Summary

ACS was suspected in a 63-year-old man with acute chest pain after physical exertion but with no electrocardiographic signs of acute myocardial infarction. Coronary angiography showed a giant left main coronary artery aneurysm. A very ectatic and calcified CX originated from the aneurysm and drained into a huge CS. There were no coronary stenoses. Transesophageal echocardiographic analysis revealed a possibly hemorrhagic pericardial effusion. Septated echodense structures were found within the CS lumen that were indicative of chronic dissection (Go Figure 1, A). Turbulent flow inside the CS was indicative of arterial pressure (Figure 1, B). Cardiac electrocardiographically . . . [Full Text of this Article]

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