[Dilated coronary sinus. A preoperative transesophageal echocardiographic diagnosis].
A 36-year old woman was presented to our hospital with congenital ventricular septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction, a transesophageal echocardiographic (TEE) baseline examination was performed, showing a severely dilated coronary sinus (CS) measuring approximately 3 cm (abnormal >1 cm). We suggested a persistent left superior vena cava (PLSVC) draining into the CS. PLSVC is a common venous congenital anomaly, with a reported incidence of 0.5% in general population and in 3-5 % of patients with congenital heart defect. Injection of echo-contrast solution in a left arm vein, visualizing microbubbles passing through the PLSVC into the CS confirmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contraindication for retrograde cardioplegia because of the loss of cardioplegia into the PLSVC resulting in a inadequate myocardial protection. It may be difficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrhythmias. A chest radiograph shows the anomalous course of the PAC along the left heart.
Paul
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Zentrum für Anaesthesiologie, Zentralkrankenhaus Links der Weser, Bremen. Paul-Walter@t-online.de
Beisel
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B
Krug
A
A
Vagt
A
A
Timpe
A
A
Brase
R
R
Leitz
K H
KH
Böhmert
F
F
Kuckelt
W
W
D000328:Adult; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D017548:Echocardiography, Transesophageal; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006345:Heart Septal Defects, Ventricular / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D011859:Radiography; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000601:surgery