TRANSESOPHAGEAL ECHOCARDIOGRAPHY COMBINED WITH MAGNETIC-RESONANCE-IMAGING FOR DETECTING VENOUS ANOMALIES IN DEXTROCARDIA - A CASE-REPORT

A fifty-six-year-old woman was admitted to Osaka Rosai hospital becaus e of dyspnea, chills, and fatigue. The patient was diagnosed by transt horacic echocardiography as having congestive heart failure due to sev ere biatrioventricular valve regurgitation, and cardiac surgery was pr oposed. Preoperative transesophageal echocardiography (TEE) revealed a dilatation of the coronary sinus (CS), a right-sided hemiazygos vein (R-AZ), and another great vessel lying between the CS and the R-AZ. Ma gnetic resonance imaging (MRI) was also performed, and this showed a p ersistent right superior vena cava (PRSVC) entering the left atrium vi a the dilatated CS. However, the site of connection between the R-AZ a nd the PRSVC could not be detected by MRI because of inadequate slice acquisition. Each method has its limitations, particularly with regard to visualizing the extracardiac vascular system. Therefore, the autho rs demonstrated that the combination of TEE and MRI might be more usef ul than each alone, and the combination is as a valuable method as dig ital subtraction angiography for the diagnosis of extracardiac venous anomalies.