Left‐Sided High‐Flow Arteriovenous Hemodialysis Fistula Combined with a Persistent Left Superior Vena Cava Causing Coronary Sinus Dilatation

We present an interesting case illustrating the possible hemodynamic consequences when a left‐sided arteriovenous hemodialysis fistula is combined with the congenital anomaly of a persistent left superior vena cava (PLSVC). Our case illustrates the importance of an echocardiographic examination with attention to the coronary sinus (CS) caliber—raising suspicion of a PLSVC—in the assessment for the hemodialysis access in end‐stage renal disease patients. The causes and symptoms of CS dilatation, as well as the literature on PLSVC, are also discussed in detail.