How should i treat a left persistent superior vena cava with unroofed coronary sinus associated with severe stenosis and regurgitation of aortic homograft placed in the tricuspid position?

Abstract

BACKGROUND: A 21-year-old man with a history of atrial septal defect (ASD) and ventricular septal defect (VSD) repair and tricuspid valve (TV) replacement with size 22 mm aortic homograft presented complaining of severe shortness of breath. Clubbing and cyanosis of the fingers were noted. SpO2 on room air was 80-84%. INVESTIGATION: Physical examination, electrocardiogram, chest X-ray, transthoracic echocardiography, CT scan, right cardiac catheterisation. DIAGNOSIS: Persistent left superior vena cava draining into the left atrium through an unroofed coronary sinus, severe stenosis and regurgitation of homograft in the tricuspid position. MANAGEMENT: Percutaneous closure of left superior vena cava draining into the left atrium through an unroofed coronary sinus with concomitant percutaneous implantation of a Melody valve in the tricuspid position.