Echocardiographic Diagnosis of Anomalous Drainage of the Superior Vena Cava Into the Left Atrium
A 1-day-old, 2805 g baby girl who was carried to term was cyanotic shortly after birth. Pulse oximetry documented an oxygen saturation of 65%. The saturation improved to 80% with hyperoxic challenge. Physical examination revealed a grade II/VI long systolic murmur best heard at the base of the heart, and a mid-diastolic rumble at the left lower sternal border. The ECG exhibited left ventricular hypertrophy. Chest roentgenogram demonstrated cardiomegaly with normal pulmonary vascular markings and a slightly widened mediastinum. A 2-dimensional transthoracic echocardiogram revealed marked dilatation of the left-sided cavities and ductus arteriosus with left-to-right shunt. A right-sided superior vena cava (SVC) drained exclusively into the left atrium (Figure 1). This finding was confirmed by an intravenous injection of agitated saline in the left antecubital area (Figure 2).
The patient was diagnosed with an abnormal connection of SVC to the left atrium, intact atrial septum, and patent ductus arteriosus. These findings were confirmed in the operating room (Figure 3). Additionally, the pulmonary venous returnof the right upper lobe was noted to enter the SVC. The SVC was reimplanted to the right atrium on cardiopulmonary bypass. The patient had an uneventful recovery.
The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.
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