Venous anomalies of the coronary sinus: detection by M-mode, two-dimensional and contrast echocardiography.

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Abstract
The echocardiographic features of the enlarged coronary sinus are described in 8 patients [1 day to 18 yr old] with a left superior vena cava draining to the coronary sinus and 2 patients with total anomalous pulmonary venous connection to the coronary sinus. The diagnosis was confirmed in each patient by cardiac catheterization and surgery. In the M-mode echocardiogram, a dense echo was present posterior to the mitral valve at the level of the atrioventricular junction. The clear space immediately behind this echo represented the enlarged coronary sinus. On the 2-dimensional echocardiographic examination, the enlarged coronary sinus was seen in several planes; the structure was imaged best with the parasternal long-axis view. In the long-axis plane in the 8 patients with a left superior vena cava, the coronary sinus was visualized as a distinct circular structure lying posteriorly in the atrioventricular junction. In the 2 patients with total anomalous pulmonary venous connection, the confluence of the pulmonary veins and its connection to the coronary sinus were imaged in the long-axis plane. These findings were substantiated by contrast M-mode and 2-dimensional echocardiograms in 5 patients. The M-mode and 2-dimensional echocardiographic examinations allowed detection of the enlarged coronary sinus and diagnosis of certain venous anomalies that caused increased coronary sinus blood flow. The 2-dimensional echocardiographic examination easily distinguished the enlarged coronary sinus from other congenital lesions that cause anomalous echoes behind the anterior mitral valve leaflet on M-mode echocardiographic examination.