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Updated: Apr 25, 2026

Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
Inferior Sinus Venosus Defect: Inconclusive Transesophageal Echocardiography Clarified by Computed Tomography and
Go Hashimoto1, Yutsuki Tsukagoshi1, Atsuhiro Saito1
1Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
Background:
Inferior sinus venosus (SV) atrial septal defect (ASD) is a rare interatrial communication, found near the inferior vena cava (IVC)-right atrial (RA) junction, that may be overlooked on transesophageal echocardiography (TEE).
Case Summary:
A 52-year-old woman with childhood secundum ASD closure presented with progressive right heart enlargement. Transthoracic echocardiography showed marked right-sided dilation without a detectable shunt. TEE confirmed an intact fossa ovalis patch but did not adequately visualize the IVC-RA junction. Electrocardiogram-gated cardiac computed tomography (CT) revealed an inferior SVASD with anomalous drainage of 2 right lower pulmonary veins into the RA. Intracardiac echocardiography (ICE) identified a low interatrial communication and Doppler evidence of anomalous pulmonary venous inflow. Surgical baffle repair redirected pulmonary venous return to the left atrium without complications.
Discussion:
CT and ICE provided complementary anatomic and functional information when TEE was inconclusive.
Take-Home Messages:
TEE may not detect inferior SVASDs. CT and ICE serve as critical complementary modalities.
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