Inadvertent Diversion of Superior Vena Cava to the Left Atrium- A Diagnosis Made by Bubble Contrast Echocardiography

• Main Authors: Mahendra Tilkar, Agam Bansal
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2018-11-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: endocardium; pulmonary hypertension; sinus venosus atrial septal defect; transoesophageal
• Online Access: https://jcdr.net/articles/PDF/12194/37269_CE[Ra1]_F(SL)_PF1(MJ_AP)_PN(SHU).pdf

Sinus venosus Atrial Septal Defect (ASD) is the abnormal drainage of pulmonary veins to right atrium, which can present with symptoms of pulmonary hypertension. Sinus venosus ASD presents a diagnostic challenge considering low detection rates using transthoracic echocardiography. We report a case of a 36-year-old female in whom the sinus venosus ASD was wrongly diagnosed as primary pulmonary hypertension. Also, the role of transoesophageal and bubble contrast saline echocardiography in detecting an adequate closure of sinus venosus ASD after the surgical repair was presented. Based on transthoracic echocardiography and ECG findings, the patient was diagnosed with primary pulmonary hypertension. Because of the persistent symptoms and failure to improve with Bosentan, Sildenafil and diuretics, the patient was advised Transoesophageal Echocardiography (TEE), which revealed superior venacava sinus venosus ASD. The patient had surgical closure of the defect but she developed cyanosis and hypoxemia after the surgery. The bubble contrast saline echocardiography was performed for detecting adequate closure of the defect. The bubble contrast echocardiography showed simultaneous opacification of all the four chambers of heart. Thereby, a repeat surgery was done and patient experienced improvement in her symptoms. The present case concludes that bubble contrast saline echocardiography can be used to detect the presence of intra and extra-cardiac shunt.