Video commentary on "imaging the coronary sinus".

A persistent PLSVC results from failure of the left anterior cardinal vein to obliterate.

It is the commonest variation in the anomalous venous return of the heart.

Dilated Coronary sinus on ECHO confirmed by saline contrast echocardiography.

Increased likelihood of CHD if there is no right-sided SVC or if the LSVC drains into the left atrium (LA).

TEE is more accurate in visualizing these posterior cardiac structures and provides better delineation of coronary sinus.

Coronary sinus diameter - 6.6 ± 1.54-10

Coronary sinus width > 2cm is suggestive of LSVC

LSVC drains directly into the CS leading to CS dilation

“Bubble study” from left upper extremity will demonstrate CS contrast followed by RA contrast

A negative bubble contrast test does not exclude the possibility of a left SVC, since a large in nominate vein and small left SVC can coexist.

Standard TEE Views for Coronary Sinus are:

∘ ME coronary sinus view

∘ ME 2 chamber view

∘ ME modified bicaval view

∘ TG basal short axis view (coronary sinus view)

Atypical LSVC drainage into the LA results in:-

A right to left shunt,

cyanosis,

paradoxical thromboembolism,

air and septic embolism