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A 38-year-old woman with atypical chest pain and exertional dyspnoea was referred to our service for a diagnostic work-up. Transthoracic echocardiography showed an enlarged coronary sinus (CS) and enlarged right-sided heart chambers without obvious atrial septal defect ( Panel A ). After injection of agitated saline contrast into the left cubital vein, immediate appearance of bubble contrast was noted in the CS and the right atrium …

The answer lies in the bubbles: a patient with superior sinus venosus defect, persistent left superior vena cava, and absent innominate vein