Correct!
2. Most patients present because they are symptomatic from a right left intra-cardiac shunt

The patient has a persistent left superior vena cava with anomolous drainage of the right internal jugular vein to the coronary sinus. This is the most common congenital abnormality of the venous system in the chest (1-4). Most patients are asymptomatic. The tip of the pacer appears to perforate the right ventricle (Figure 3). However, the lack of a pericardial effusion suggests that it is probably just tenting the muscle up. (Gotway MB personal communication).

Figure 3. The pacer tip (red arrowhead) is upturned and projects beyond the RV musculature (at tip of yellow arrowhead) probably tenting the muscle up.

What should be done at this point? (Click on the correct answer to proceed to the fifth and final panel)

1. Echocardiogram for associated conditions such as VSD, single atrium, pulmonary stenosis and ASD.
2. No further evaluation is needed.
3. Remove the pacer wire.
4. 1 and 3.
5. None of the above.

Home/Critical Care