DK2985_C000 1..28 - AlSharqia Echo Club

502 Transesophageal Echocardiography(A)(B)LV TENDONVSDRVLV(C)Figure 23.7 (A, B) Transgastric mid-papillary view in a 67-year-old woman with a ventricular septal defect (VSD). Note the leftventricular tendon seen close to the VSD. (C) A left-to-right shunt was present (LV, left ventricle; RV, right ventricle).Significant lipomatous infiltration can also occuraround the tricuspid annulus, simulating a mass effect.Periaortic fat accumulation, mostly around the descendingAo needs to be differentiated from thrombus filling a falselumen.D. Anomalous Left Superior Vena CavaA persistent left SVC can be found in 0.3–0.5% of normalindividuals and in 3–10% of patients with other congenitalanomalies (7). It is visualized between the left upper pulmonaryvein and the LAA. The left SVC drain to theLA, or to the RA via the CS which secondarily willappear dilated. The diagnosis of a left SVC draining inthe CS can be made by injecting agitated saline in theleft upper extremity. The microbubbles are first seen inthe left SVC and the CS followed by opacification of theRA. The recognition of the presence of a left SVC isimportant as cannulation of the CS may have significantdifferent consequences in patients undergoing pulmonary(A)(B)IVCLARALIPOMATOUSHYPERTROPHYSVCFigure 23.8 Lipomatous hypertrophy of the interatrial septum (IVC, inferior vena cava; LA, left atrium; RA, right atrium; SVC,superior vena cava).