Saphenous graft on transesophageal echocardiogram masquerading as an abnormal vascular communication into the right...

Area of Science:

• Cardiology
• Medical Imaging
• Vascular Surgery

Background:

• A patient with a history of coronary artery bypass grafting presented with an incidental finding of aberrant flow in the right atrium during transesophageal echocardiography (TEE).
• The initial TEE also noted a severely dilated left atrium, moderate aortic regurgitation, and moderate aortic stenosis.

Observation:

• Transesophageal echocardiography (TEE) initially suggested an abnormal vascular communication or aberrant flow within the right atrium.
• The echocardiogram revealed a normal-sized left ventricle but a significantly dilated left atrium.

Findings:

• Cardiac magnetic resonance angiography (CMRA) was performed to clarify the TEE findings.
• CMRA demonstrated that the suspected abnormal communication was actually a vascular graft positioned adjacent to the coronary sinus.

Implications:

• This case highlights the importance of multi-modality imaging for accurate diagnosis of complex cardiac and vascular structures.
• Understanding the precise anatomical relationship of vascular grafts is crucial for interpreting echocardiographic findings and avoiding misdiagnosis.
• The findings underscore the need for careful evaluation of incidental vascular findings in patients with prior cardiac surgery.