Echocardiography of the Inferior Vena Cava, Superior Vena Cava, and Coronary Sinus in Right Heart Failure

Echocardiographic evaluation of the three major systemic venous channels that drain directly into the right atrium has hitherto received less attention than it deserves. Attention had been paid initially to inferior vena cava dilatation and lack of collapsibility (plethora) as signs of systemic venous congestion. Superior vena cava imaging has not been part of routine echographic evaluation; however, our recent observations on superior vena cava appearance by the right supraclavicular approach provide evidence that dilatation of superior vena cava correlates with that of inferior vena cava as a marker for venous congestion. The coronary sinus caliber, which has been virtually ignored, may also provide echographic signs of systemic congestion, namely, dilatation and lack of normal narrowing during atrial contraction.