Successful surgical repair of a giant left main @entity574 with @entity2548 draining into a persistent XXXX and coronary sinus: role of intraoperative transesophageal echocardiography.

@entity1 @entity712 @entity4264 @entity1007 @entity101 @entity301 @entity120 @entity2548 @entity574
We report the case of a 74-year-old @entity1 with a history of @entity101 , @entity1007 , and pacemaker who presented to the hospital with new onset New York Heart Association class IV @entity712 . Transthoracic echocardiography revealed a markedly dilated right ventricle with normal right ventricular systolic function. There was moderate @entity120 with an estimated pulmonary artery systolic pressure of 60 mm Hg. Her echocardiogram 1 year earlier had demonstrated normal right ventricular size and systolic function, and no @entity120 . Additional transthoracic imaging with saline contrast study through a left peripheral vein demonstrated the presence of a dilated coronary sinus with a persistent @entity4264 . Color Doppler demonstrated turbulent flow within the coronary sinus with evidence of significant left-to-right shunting. Cardiac catheterization revealed a massively dilated left main @entity574 with an @entity2548 into the @entity4264 and coronary sinus. The calculated Qp/Qs was 2:1. The @entity1 underwent 2 unsuccessful attempts at percutaneous intervention to occlude the @entity2548 . She then underwent successful surgical closure of the @entity301 . The important role of intraoperative transesophageal echocardiography in guiding this technically challenging surgical case is discussed.
