Dilated Coronary Sinus: The Usual Persistent Left Superior Vena Cava or a Less Common Etiology?

Abstract

AN 84-YEAR-OLD MAN, 70 kg, 183 cm, with hypertension and left ventricular hypertrophy, presented to the authors’ institution with a history of progressive shortness of breath and abdominal distention. A large amount of ascites was present, necessitating biweekly paracentesis. The patient's functional capacity had significantly deteriorated. He described severe dyspnea associated with bending forward and standing from a sitting position. The physical examination was notable for cachexia, a grade- 3 holosystolic murmur heard best at the lower left sternal border, and a pulsating right upper quadrant. Relevant laboratory findings included a BNP level of 687 pg/mL. Transesophageal echocardiography (TEE) was performed as part of the diagnostic evaluation, and the following images were obtained (Fig. 1, 2, and 3; video clips 1 and 2). What is the diagnosis? Fig 2Midesophageal 2-chamber transesophageal echocardiography view. View Large Image Figure Viewer Download Hi-res image Fig 3Modified midesophageal 4-chamber color Doppler transesophageal echocardiography image. View Large Image Figure Viewer Download Hi-res image