A Rare Congenital Triad in an Adult With Coronary Artery Disease: A Case Report From Georgia

A 47-year-old man with a history of New York Heart Association (NYHA) class III heart failure and paroxysmal atrial fibrillation presented with recurrent chest pain, exertional dyspnea, and exercise intolerance. He was diagnosed with an acute myocardial infarction and underwent stenting of the left anterior descending artery. During the same hospitalization, transthoracic echocardiography revealed a sinus venosus atrial septal defect (ASD), moderate tricuspid regurgitation, and right heart dilation, raising suspicion for partial anomalous pulmonary venous drainage (PAPVD). Further imaging confirmed a 1.1 cm sinus venosus ASD with a left-to-right shunt, PAPVD of the right superior pulmonary veins into the superior vena cava (SVC), and a persistent left SVC draining into the coronary sinus. Coronary angiography demonstrated multivessel coronary artery disease. The patient underwent successful surgical correction, including coronary artery bypass grafting and intracardiac repair with rerouting of anomalous pulmonary veins to the left atrium and ASD closure using an autologous pericardial patch. Postoperative recovery was uneventful aside from transient supraventricular tachycardia with preserved sinus node function and no conduction abnormalities or need for a pacemaker. Two follow-up echocardiographs demonstrated normalization of right heart dimensions, resolution of the shunt, and preserved ejection fraction. This case underscores the importance of considering congenital anomalies in adult patients with new or worsening cardiac symptoms, particularly when incidental findings emerge during evaluation for ischemic heart disease.