Dilated coronary sinus. A preoperative transesophageal echocardiographic diagnosis

A 36-year old woman was presented to our hospital with congenital ventricul ar septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction,a tra nsesophageal echocardiographic (TEE) baseline examination was performed, sh owing a severely dilated coronary sinus (CS) measuring approximately 3 cm ( abnormal >1 cm). We suggested a persist ent 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 w ith congenital heart defect. Injection of echo-contrast solution in a left arm vein,visualizing microbubbles passing through the PLSVC into the CS con firmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contrain dication for retrograde cardioplegia because of the loss of cardioplegia in to the PLSVC resulting in a inadequate myocardial protection. It may be dif ficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrythmias. A chest rad iograph shows the anomalous course of the PAC along the left heart.