An Unusual Intraoperative Transesophageal Echocardiographic Approach to Detect Acute Superior Vena Cava Syndrome in Mitral Valve Repair: A Case Report.

The diagnosis of superior vena cava (SVC) syndrome is always challenging, even more so when it happens intraoperatively. An usual transgastric-transesophageal projection allows for the visualization and quantification of caval flow acceleration, critical in leading to rapid diagnosis and quick reaction in the operative setting. We present the case of a patient who underwent successful mitral valve reconstruction and left atrial appendage closure via median sternotomy on cardiopulmonary bypass and, intraoperatively, developed iatrogenic SVC syndrome with hypotension, facial cyanosis, and conjunctival edema. We used an uncommon deep transgastric-transesophageal echocardiographic projection, which proved crucial in promptly identifying SVC stenosis and in immediate intraoperative management. Our case report shows the efficacy of this dedicated deep-transgastric view, which may be included as part of a routine echocardiographic exam in operations that require bicaval cannulation, leading to increased risk of acute SVC stenosis.