Persistent Left Superior Vena Cava during Aortic Valve Replacement

Copyright: © 2014 Hong T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. A 57-year-old African American man with a 6-month history of chest pain presented for aortic valve replacement. He had documented severe aortic stenosis, moderate aortic insufficiency, left ventricular hypertrophy and an ejection fraction (EF) of 50% on a preoperative transthoracic echocardiography (TTE). After an uneventualful induction, a prebypass transesophageal echocardiography (TEE) revealed a calcified tricuspid aortic valve with severe stenosis (aortic valve area 0.7 cm2; AV mean gradient 40 mmHg), severe aortic insufficiency, and an EF of 35%. His coronary sinus was significantly dilated. The X-plane view at the midesophageal (ME) 2-chamber revealed a diameter of 2.09 cm (Figure 1). The diagnosis of persistent left superior vena cava (PLSVC) was made by a bubble study (Figure 2). This finding was further confirmed by the inability to perform retrograde cardioplegia. The enlarged coronary sinus (CS) is well demonstrated in 3-Dimension (3-D) TEE (Figure 3). Once the surgeon was informed of the findings,and other potential associated congenital anomalies ruled out, the cardioplegia solution was injected directly into the coronary arteries and then proceeded with the 21-mm On-X aortic valve replacement. The rest of the procedure was uneventful and the patient was transported to the Surgical intensive care unit (SICU) in stable condition. Later, the patient had computer tomography (CT) scan of his chest for evaluation of his lung nodules. It confirmed the intraoperative TEE diagnosis (Figure 4).