An unusual clinical presentation resembling superior vena cava syndrome post heart surgery

Although both clinical findings and hemodynamic derangements completely resolved following tricuspid valve repair aimed to correct the new onset severe tricuspid regurgitation noted post operatively; a clear mechanism was not readily obvious and diagnostic testing data somewhat conflictive. We present a careful retrospective examination of all clinical data and review possible clinical entities that could have been implicated in this particular case and recognize that transesophageal echocardiographic findings were most useful in identifying the best course of action.After reviewing all clinical data and despite the inconclusive nature of test results; the retrospective examination of transesophageal echocardiographic findings proved to be most useful in identifying the best course of action. We postulate that in our case, resolution of the suspected pulmonary embolism with anticoagulation and reestablishment of a normal right ventricular geometry with tricuspid valve repair worked in unison in restoring normal hemodynamics and resolving both dyspnea and venous dilatation.It has been suggested that when patients suffer unexpected findings or develop multiple complications after any intervention, adverse outcomes might be expected if a strategy is not promptly implemented to identify the offending or triggering mechanism(s). In this case we present a patient who underwent surgical resection of filamentous aortic valve masses, closure of a patent foramen ovale, and performance of a modified Maze procedure for atrial fibrillation who then developed a series of unusual post operative events heralded by hemodynamic deterioration, dyspnea and rapidly progressive dilatation of superficial neck and facial veins, resembling a superior vena cava syndrome; two days post surgery. A careful retrospective examination of all clinical data is presented with a detailed review of all possible clinical entities.A 72-year-old woman with chronic atrial fibrillation, temporal arteritis,