Coronary orifice atresia and diverticula are considered rare congenital conditions. Our understanding of the coronary sinus (CS) and venous drainage anatomy plays a crucial role in performing interventions and surgical procedures required to improve treatment options and related prognosis for these patients. The case study described herein involves a 29-year-old female patient who was diagnosed with coronary orifice atresia and diverticula. The patient's electrocardiography revealed normal sinus rhythm, short PR interval, and delta wave. Transthoracic echocardiography results showed the subject also suffered from mild CS dilation associated with coronary orifice atresia and diverticula. Our clinical intervention included the use of agitated saline injection which was administered intravenously into the patient's left arm. Our clinical observations during the administration of agitated saline solution did not indicate the presence of any detectable air bubbles entering into the CS. The results of two-dimensional and color flow Doppler study showed that CS connection to the right atrium appeared to be atretic. During our examination, we were also successful in detecting a pulsatile free echo space which was connected through an isthmus to the CS. Electrophysiology study and coronary angiogram performed on the subject confirmed our clinical diagnosis and findings of CS atresia, diverticula, and left superior vena cava.

This study reports our initial experience with robotic-assisted partial anomalous pulmonary venous connection (PAPVC) repair. From May 2013 through September 2018, 20 patients (12 male and 8 female) underwent robotic-assisted repair of a right-sided (n = 19) or a left-sided (n = 1) PAPVC. The mean age was 24.6 ± 9.4 years (range 14-44) and the mean body mass index was 22.3 ± 4.6. Seventeen patients had a right-sided supra-cardiac PAPVC with sinus venosus atrial septal defect, two had a right-sided cardiac PAPVC to the right atrium and one had a left-sided cardiac PAPVC to the coronary sinus. Associated anomalies included patent foramen ovale (n = 2) and left persistent superior vena cava (n = 1). All patients were operated on successfully. No conversion to mini-thoracotomy or sternotomy was needed. Cardiopulmonary bypass and aortic clamping times were 114.8 ± 17.3 (range 90-150) and 66.5 ± 15.8 (range 44-90) minutes, respectively. Repair techniques included the single-patch repair with baffle through right atriotomy (n = 16), the 2-patch repair (n = 1) using lateral transcaval incision and intracardiac re-routing (n = 3). The mean ventilation time was 4.2 ± 1.2 h and hospital stay was 3.1 ± 0.1 days. No phrenic nerve injury, sinus node dysfunction, re-exploration or blood transfusion was noted. No residual shunting or venous obstruction was found on echocardiograms. Follow-up was a mean of 1.7 years (range 3-36 months). There was no follow-up mortality. Totally, endoscopic robotic-assisted PAPVC repair is a feasible procedure in selected adult patients. It is a less invasive alternative to traditional incisions, mini-thoracotomy and endoscopic approaches. In the future, new generation robotic devices may offer an alternative for younger patients with this pathology.