Progressive dyspnea and signs of right heart dysfunction

Area of Science:

• Cardiology
• Medical Imaging
• Echocardiography

Background:

• Transthoracic echocardiography is the initial imaging modality for evaluating right heart abnormalities.
• Sinus venosus defects (SVD) are congenital heart anomalies that can lead to significant left-to-right shunting.
• Right heart volume overload and tricuspid insufficiency can complicate the diagnosis of SVD.

Observation:

• A 40-year-old woman presented with dyspnea and fever, exhibiting signs of right heart volume overload and tricuspid valve vegetations.
• Transesophageal echocardiography identified a sinus venosus defect (SVD) with a substantial left-to-right shunt.
• Computed tomography, initially for pulmonary embolism, revealed interatrial communication, aiding in the SVD diagnosis.

Findings:

• The presence of tricuspid insufficiency and volume overload made the SVD diagnosis more complex.
• Transthoracic echocardiography has low detection rates for SVD.
• Advanced imaging techniques are essential for diagnosing SVD in patients with unexplained right heart dilatation.

Implications:

• This case highlights the diagnostic challenges associated with SVD, particularly when other cardiac conditions are present.
• Emphasizes the need for comprehensive imaging strategies beyond initial echocardiography for accurate SVD diagnosis.
• Underscores the importance of considering SVD in the differential diagnosis of unexplained right heart enlargement and dysfunction.