Covered Stent Correction of Sinus Venosus ASD With Anomalous Left Sinus Interarterial Right Coronary Artery.

backgroundLate presentation worsens the morbidity of adult congenital heart disease. Concurrent defects and associated anomalous coronary artery from the opposite sinus (ACAOS) complicates management. CASE SUMMARY: A 62-year-old man was referred by his urologist because of a murmur. Multimodality imaging unraveled concurrent defects: 1) interarterial coursing right coronary artery originating from the left sinus; 2) anomalous left circumflex artery from the first diagonal branch of the left anterior descending artery; 3) sinus venosus atrial septal defect (SVASD); 4) anomalous right upper pulmonary vein drainage into the superior vena cava; and 5) persistent left superior vena cava. A successful covered stent closure of the SVASD was achieved after stratifying associated coronary anomalies as low risk. DISCUSSION: The presence of multiple concurrent defects is associated with progressive hemodynamic cardiac injury even in seemingly asymptomatic patients. Presence of ACAOS influences candidacy for transcatheter versus surgical repair and must be looked for and risk stratified using multimodality imaging. Covered stent correction of SVASD has a 95% success rate and very low complication rate. TAKE-HOME MESSAGES: Multimodality imaging is key for full diagnostic evaluation and preprocedural planning for safe and effective transcatheter closure of SVASD. In the presence of anomalous coronary artery from the opposite sinus, a covered stent correction of SVASD is favorable after adequate risk stratification to exclude high-risk features.