Concomitant Persistent Left Superior Vena Cava and Agenesis of Right Superior Vena Cava

Abstract

A 21-year-old white male athlete was admitted for syncope. ECG and telemetry showed sinus arrhythmia and sinus bradycardia; at this time, he was asymptomatic. A chest radiograph showed unremarkable findings (Figure 1). During his transthoracic echocardiogram, a massive coronary sinus (area, 3.9 cm2) was identified (Figure 2). Because of suspicion of a persistent left superior vena cava (PLSVC), an agitated saline (“bubble”) study was immediately performed. After injection of agitated saline through his left antecubital vein, the dilated coronary sinus was opacified before the right atrium and ventricle, consistent with PLSVC (Figure 3 and Movie I in the online-only Data Supplement). Figure 1. Anteroposterior projection of the plain chest radiograph showing normal cardiac size. Figure 2. Parasternal …