title: An unusual clinical presentation resembling superior vena cava syndrome post heart surgery.
abstract: BACKGROUND
  An unusual sequence of post operative events heralded by hemodynamic deterioration followed by dyspnea and rapidly progressive dilatation of superficial neck and facial veins, resembling a superior vena cava syndrome, two days post surgical resection of filamentous aortic valve masses, closure of a patent foramen ovale, and performance of a modified Maze procedure for atrial fibrillation in a patient that presented with transient neurologic findings is presented.
  
  
  METHODS
  Although both clinical findings and hemodynamic derangements completely resolved following tricuspid valve repair aimed to correct the new onset severe tricuspid regurgitation noted post operatively; a clear mechanism was not readily obvious and diagnostic testing data somewhat conflictive. We present a careful retrospective examination of all clinical data and review possible clinical entities that could have been implicated in this particular case and recognize that transesophageal echocardiographic findings were most useful in identifying the best course of action.
  
  
  CONCLUSIONS
  After reviewing all clinical data and despite the inconclusive nature of test results; the retrospective examination of transesophageal echocardiographic findings proved to be most useful in identifying the best course of action. We postulate that in our case, resolution of the suspected pulmonary embolism with anticoagulation and reestablishment of a normal right ventricular geometry with tricuspid valve repair worked in unison in restoring normal hemodynamics and resolving both dyspnea and venous dilatation.
authors.affiliation: Cardiothoracic Division, Department of Surgery, The Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. lopezcandalesa@upmc.edu
authors.forename: Angel
authors.initials: A
authors.lastname: López-Candales
authors.forename: David
authors.initials: D
authors.lastname: Kaczorowski
authors.forename: Ronald
authors.initials: R
authors.lastname: Pellegrini
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D005260:Female; D006338:Heart Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D009232:Myxoma / Q000000981:diagnostic imaging / Q000601:surgery; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D035583:Rare Diseases / Q000000981:diagnostic imaging; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging* / Q000601:surgery*; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery; D014683:Vena Cava, Superior