His preoperative transthoracic echocardiogram (TTE) was notable for normal biventricular function, severe AR, and a possible patent foramen ovale (PFO). No details about the coronary sinus were provided on the TTE report. Intraoperatively, the patient underwent an uneventful induction of general anesthesia.
Transesophageal echocardiography (TEE) was then performed and confirmed the preoperative findings with the exception that there was no PFO identified. Other notable findings, however, were also discovered on TEE.
During placement of a central venous catheter in the right internal jugular vein, TEE was used to visualize the guidewire. It was noted at this time that the right SVC appeared small.
In addition, the coronary sinus was observed to be significantly dilated, measuring 2.1 cm in the deep midesophageal 4-chamber view and 3.3 cm in the midesophageal 2-chamber view.
These echocardiographic findings raised suspicion for a PLSVC. A left-sided intravenous line was in place so a bubble study was attempted. Injection of agitated saline showed bubbles appearing in the coronary sinus prior to entering the right atrium, although the study was limited by the relatively low number of bubbles.
The suspicion for a PLSVC was communicated to the surgical team given the possible implications for retrograde cardioplegia administration. However, at that time, they were not able to visually identify a PLSVC.