Fig. 1

Intraoperative transesophageal echocardiography and agitated saline test before unroofed coronary sinus repair. Intraoperative transesophageal echocardiography (TEE) revealed an enlarged coronary sinus (CS) and structures suggestive of an unroofed coronary sinus (URCS) fistula in the a short-axis and b long-axis views. However, color Doppler imaging failed to detect any obvious shunt flow. When 20 mL of agitated saline is vigorously administered via an intravenous line from the left upper extremity, the agitated saline flowing from the CS into the left atrium can be easily observed (c and d). CS, coronary sinus; LA, left atrium; LV, left ventricle; Ao, ascending aorta