Coronary Embolism From a Sinus Venosus ASD With PAPVD

Q4 Medicine

JACC. Case reports Pub Date : 2025-10-01 DOI:10.1016/j.jaccas.2025.105220

Jasper Lin MD , Bradley Hefford BSc , Jeremy Hefford BSc , Eric Jacombs BSc , Rowena Solayar MD , Simon Kang MD , Sylvio Carvalho Junior Provenzano MD , Maria Gabriela Matta MD

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Abstract

Background

Paradoxical embolism (PDE) is a rare, underrecognized cause of acute coronary syndrome, occurring when a thrombus crosses an intracardiac defect into systemic circulation. Sinus venosus atrial septal defects (ASDs), often associated with partial anomalous pulmonary venous drainage, may manifest in adulthood with complications such as PDE.

Case Summary

We describe a 52-year-old man presenting with non-ST elevation myocardial infarction. Coronary angiography showed a distal right coronary occlusion suggestive of embolic infarction. Transthoracic echocardiography with bubbles revealed a right-to-left shunt. Transesophageal echocardiography confirmed a sinus venosus ASD with partial anomalous pulmonary venous drainage. Surgical correction with intra-atrial baffle and ASD closure was successful.

Discussion

This case highlights the importance of considering PDE in myocardial infarction in the absence of risk factors. Multimodality imaging was key to diagnosis and guiding treatment.

Take-Home Messages

PDE is an underrecognized cause of acute coronary syndrome mechanism. Structural heart defects must be ruled out in coronary embolism or cryptogenic myocardial infarction.

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静脉窦ASD合并PAPVD的冠状动脉栓塞

背景：矛盾栓塞（PDE）是一种罕见的，未被充分认识的急性冠状动脉综合征的病因，当血栓穿过心脏内缺陷进入体循环时发生。静脉窦性房间隔缺损（ASDs）通常与部分肺静脉引流异常相关，可在成年期出现PDE等并发症。我们描述了一个52岁的男性表现为非st段抬高心肌梗死。冠状动脉造影显示右冠状动脉远端闭塞提示栓塞性梗死。经胸超声心动图显示右至左分流。经食管超声心动图证实静脉窦性ASD伴部分肺静脉异常引流。手术矫正与房内挡板和ASD关闭是成功的。本病例强调了在没有危险因素的情况下考虑PDE在心肌梗死中的重要性。多模态影像是诊断和指导治疗的关键。espde是一种未被充分认识的导致急性冠状动脉综合征的机制。冠状动脉栓塞或隐源性心肌梗死必须排除结构性心脏缺陷。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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