case_images: PMC9997470_01
case_images: (a) Aortogram demonstrating a large left to right shunt. (b) Midesophageal short-axis view of the coronary sinus showing the patent vein graft delivering pulsatile blood in systole. (c and d) Midesophageal 4 chamber retroflexed to highlight the opening of the coronary sinus into the right atrium. In (c) the vein graft is open and there is turbulent flow in the systole. In (d) the vein graft has been occluded, and the turbulent flow in the systole is no longer present
case_images: ACA-26-83-g001.jpg
case_images: PMC9997470_01_ACA-26-83-g001.jpg
case_images: F1
case_images: Preoperative coronary angiography demonstrated left to right shunt consistent with an aortic to coronary sinus saphenous vein graft [Figure 1a], with persistent ostial left main stenosis, a near occluded LIMA to the LAD, and a widely patent circumflex system. Real-time transesophageal echocardiography demonstrated robust pulsatility and turbulent flow within the coronary sinus that decreased significantly upon clamping the vein graft [Figure 1b-d].
case_images: Physiologic monitors including ECG, systemic arterial blood pressure, and coronary sinus pressure. Near systemic pressures can be appreciated in the coronary sinus tracing until the vein graft from the aorta to the coronary sinus is occluded with a clamp (arrow), where the pressure and absolute pulsatility decrease
case_images: ACA-26-83-g002.jpg
case_images: PMC9997470_01_ACA-26-83-g002.jpg
case_images: F2
case_images: A retrograde cardioplegia catheter was placed into the coronary sinus and was transduced, again demonstrating robust pulsatility and near aortic systolic pressures [Figure 2].