Transesophageal echocardiography and intraoperative diagnosis of persistent left superior vena cava.
OBJECTIVE
Isolated persistent left superior vena cava has an incidence of 0.5% in the normal population, but in patients with congenital cardiopathy its incidence ranges from 3% to 10%. The objective of this report was to present a case of intraoperative diagnosis with transesophageal echocardiography and to emphasize the importance of its routine use in surgical procedures for correction of congenital cardiopathies.


METHODS
This is a 16-year old male patient, ASA II, with a diagnosis of superior sinus venosus interatrial communication (IAC) with partial anomalous drainage of the pulmonary veins scheduled for the surgical correction of the cardiopathy. After induction of general anesthesia, transesophageal echocardiography (TEE) showed initially a dilation of the right cardiac chambers, a 17-mm superior sinus venosus IAC, anomalous drainage of the right superior pulmonary vein draining into the right superior vena cava (SVC), and dilation of the coronary sinus raising the possibility of persistent left superior vena cava. To confirm this suspicion, 10 mL of NS (works as a contrast in echocardiography) were injected in the venous access of the left arm, and microbubbles crossing the coronary sinus were observed immediately afterwards confirming the diagnosis of persistent left superior vena cava.


CONCLUSIONS
Routine intraoperative transesophageal echocardiography in patients with congenital cardiopathy is a fundamental auxiliary method, not only for the surgeon, often having direct influence on the surgical technique used, but also for the anesthesiologist, who can get useful information for the hemodynamic management of the patient.
da Silva
Alexander Alves
AA
São Paulo Serviços Médicos de Anestesia.
Silva
Enis Donizetti
ED
Segurado
Arthur Vitor Rosenti
AV
Kimachi
Pedro Paulo
PP
Simões
Claudia Marquez
CM
D000293:Adolescent; D017548:Echocardiography, Transesophageal; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging*