Diagnosis of Persistent Left Superior Vena Cava by Transesophageal Echocardiography During Minimally Invasive Cardiac Surgery

Figure 1. Twelve-lead electrocardiogram demonstrates a ventricular paced rhythm at 75 beats per minute.

Figure 2. Chest x-ray (posteroanterior view) demonstrates a right chest wall implantable cardioverter-defibrillator with leads in the RV and CS.

Figure 3. Two-dimensional TEE, lower esophageal 4-chamber (0°) view, demonstrates a markedly dilated CS (arrow; 2.93 cm).

Figure 4. Two-dimensional TEE, midesophageal (28°) view with counterclockwise rotation of probe, demonstrates the relation of PLSVC (∗) with the LAA (arrow).

Figure 5. (A) Two-dimensional TEE, midesophageal 4-chamber (0°) early systolic (A) and simultaneous orthogonal biplane diastolic (B) views, demonstrates the PLSVC (∗) along the lateral aspect of the LA during contrast opacification following injection of agitated saline through a left upper-extremity peripheral vein. LV, Left ventricle.

Figure 6. (A) Two-dimensional TEE, midesophageal 4-chamber (0°) serial views, demonstrates the early appearance of saline bubbles that arise via the CS to the RA (A); then the bubbles are seen to progressively opacify the RV mildly (B), moderately (C), and densely (D) following injection of agitated saline through a left upper-extremity peripheral IV catheter.

Figure 7. Two-dimensional TEE, midesophageal bicaval (109°) view, demonstrates a right SVC (∗) joining the RA along the right side of the image and a markedly dilated CS to the left (blue arrow).

Figure 8. Two-dimensional TEE, midesophageal simultaneous orthogonal biplane imaging views, demonstrates the PLSVC (∗) in a short-axis (left; 0°) and long-axis (right; 90°) display; a venous cannula (arrow) that was inserted through the left subclavian vein is also noted in the PLSVC.

Figure 9. Fluoroscopic anterior projection image demonstrates the left subclavian venous cannula position (yellow arrow) consistent with the typical PLSVC anatomy and drainage of IV contrast within the CS (blue arrow) and RA.