Surgical Creation of the Coronary Sinus Orifice in an Octogenarian With Heart Failure

Coronary sinus (CS) ostial atresia is rare, often coexisting with a persistent left superior vena cava (PLSVC), and is exceptional in elderly patients. Right-sided heart failure developed in an 82-year-old man 2 years after aortic valve replacement. Computed tomography and cardiac magnetic resonance imaging showed CS ostial closure and long-segment stenosis at the PLSVC–left brachiocephalic vein junction. At reoperation, a CS neo-ostium was created, followed by ligation of the PLSVC and tricuspid valve replacement. Postoperative imaging showed direct CS drainage into the right atrium, improved coronary venous washout, and reduced left ventricular dimension. Physiologic coronary venous reconstruction may benefit selected octogenarians with CS ostial atresia.