case_images: PMC7450329_01
case_images: The image in the left panel shows a two-dimensional presurgical midesophageal bicaval view obtained via transesophageal echocardiography (TEE) which demonstrates mild narrowing of the SVC at the SVC-right atrial junction. The image in the right panel is the same with the addition of color flow Doppler demonstrating no flow acceleration from the superior vena cava into the right atrium.
case_images: CRIA2020-8813065.001.jpg
case_images: PMC7450329_01_CRIA2020-8813065.001.jpg
case_images: fig1
case_images: Mild narrowing of the SVC at the SVC-right atrial (RA) junction was recognized on the midesophageal bicaval TEE view with no flow acceleration by color flow Doppler (Figure 1).
case_images: The image in the left panel shows the initial postbypass two-dimensional presurgical midesophageal bicaval TEE view demonstrating superior vena cava stenosis. The image in the right panel is the same with the addition of color flow Doppler demonstrating flow acceleration across the stenosis.
case_images: CRIA2020-8813065.002.jpg
case_images: PMC7450329_01_CRIA2020-8813065.002.jpg
case_images: fig2
case_images: A more thorough TEE exam showed significant flow acceleration at the SVC-RA junction distal to the superior venous cannulation site (Figure 2) as well as continually diminished ventricular volumes despite volume loading.
case_images: The image in the left panel shows the two-dimensional midesophageal bicaval TEE view after surgical revision. The image in the right panel is the same with the addition of color flow Doppler demonstrating improved flow from the SVC into the right atrium.
case_images: CRIA2020-8813065.003.jpg
case_images: PMC7450329_01_CRIA2020-8813065.003.jpg
case_images: fig3
case_images: SVC-RA junction (Figure 3). The remainder of the case proceeded uneventfully, and the patient was transported to the intensive care unit. She was extubated several hours later while on no vasopressor support.