Saphenous graft on transesophageal echocardiogram masquerading as an abnormal vascular communication into the right atrium.

An unknown aberrant flow in the right atrium observed on doppler with transesophageal echocardiogram (TEE) in a patient with prior coronary bypass. TEE revealed normal size left ventricle with severely dilated left atrium. There was moderate aortic regurgitation and moderate aortic stenosis noted. Patient was incidentally found to have an abnormal vascular communication noted to the right atrium. To further evaluate this finding, the patient underwent cardiac magnetic resonance angiography which revealed that the tubular structure noted on TEE was actually a graft that was abutting onto the coronary sinus, and the flow anomaly was really the graft coming up and running adjacent to the coronary sinus.