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Gigantic Coronary Sinus Associated with Concurrent Persistent Left Superior Vena Cava and Right Ventricular Volume Overload

Authors:

Selim R. Krim,

Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Selim R.
M.D.
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Aibo F. Jiang,

Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Aibo F.
RCS, RDCS
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Rey P. Vivo,

Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Rey P.
M.D.
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Stephen H. Little,

Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Stephen H.
M.D.
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Su Min Chang

Methodist DeBakey Heart & Vascular Center, Houston, Texas, US
About Su Min
M.D.
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Abstract

Case Presentation

A 76-year-old woman with known atrial fibrillation and congestive heart failure presented with increasing shortness of breath. A 2-dimensional (2-D) transthoracic echocardiogram was performed to assess left ventricular function. An incidental finding of a very large coronary sinus with a diameter of 4.8 cm was seen, raising a suspicion for the possibility of a persistent left superior vena cava (PLSVC) (Figure 1). Additional pertinent positive findings included a massively dilated right atrium (estimated volume: 538 mL), dilated tricuspid annulus with poor leaflet coaptation, severe tricuspid regurgitation, and pulmonary artery systolic pressure (PASP) of 50 mmHg with an estimated mean right atrial pressure (RAP) of 25 mmHg. After agitated saline administration into the left brachial vein, there was immediate and sequential opacification of the dilated coronary sinus, right atrium, and right ventricle, confirming the presence of a PLSVC (Figure 2). CT angiography provided detailed anatomical and morphological characterization demonstrating drainage of the PLSVC into the gigantic coronary sinus and right-sided cardiac chambers and absence of other vascular or congenital anomaly (Figures 3 and 4).

How to Cite: 1. Krim SR, Jiang AF, Vivo RP, Little SH, Chang SM. Gigantic Coronary Sinus Associated with Concurrent Persistent Left Superior Vena Cava and Right Ventricular Volume Overload. Methodist DeBakey Cardiovascular Journal. 2010;6(4):46-47. DOI: http://doi.org/10.14797/mdcvj.237
Published on 01 Nov 2010.
Peer Reviewed

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