Teenage boy with complex cardiac history s/p repair who presented with syncope. The patient’s cardiac exam showed good function with no effusion. The IVC showed that it was normal after receiving fluids and the patient felt much better. You can tell that this is the IVC because it has liver on both sides, the hepatic vein is draining into it, and the IVC is draining into the right atrium. Of note, you will also notice that the patient has a bicuspid valve with a fish-mouth appearance rather than the typical “Mercedes Benz sign.”

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