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Sonavane SK, Milner DM, Singh SP, Abdel Aal AK, Shahir KS, Chaturvedi A. Comprehensive Imaging Review of the Superior Vena Cava. Radiographics 2015; 35:1873-92. [DOI: 10.1148/rg.2015150056] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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52
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Occhetta E, Dell'Era G, Degiovanni A, Sartori C. Persistence of left superior vena cava and focal right atrial tachycardia: Challenges and interventional treatment. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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53
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Kusaka Y, Sawai T, Nakahira J, Minami T. Persistent left superior vena cava with absent right superior vena cava detected during emergent coronary artery bypass grafting surgery. JA Clin Rep 2015; 1:2. [PMID: 29497634 PMCID: PMC5818686 DOI: 10.1186/s40981-015-0004-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 07/14/2015] [Indexed: 11/18/2022] Open
Abstract
Although persistent left superior vena cava (PLSVC) itself is a common venous anomaly in congenital heart disease, PLSVC with absent right superior vena cava (RSVC) is a rare venous congenital malformation. Due to the lack of symptoms, this malformation is often detected fortuitously when patients undergo central venous catheter placement, pacemaker implantation, or open cardiac surgery. This particular venous malformation is rare, but clinicians in many fields should be well aware of its variations and management techniques to avoid complications. Anesthesiologists should know that patients with PLSVC rarely have absent RSVC. TEE was helpful in the diagnosis of PLSVC with absent RSVC during emergent surgery.
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Affiliation(s)
- Yusuke Kusaka
- Department of Anesthesiology, Osaka Medical College, Daigakumachi 2-7, Takatsuki, Osaka 569-8686 Japan
| | - Toshiyuki Sawai
- Department of Anesthesiology, Osaka Medical College, Daigakumachi 2-7, Takatsuki, Osaka 569-8686 Japan
| | - Junko Nakahira
- Department of Anesthesiology, Osaka Medical College, Daigakumachi 2-7, Takatsuki, Osaka 569-8686 Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Daigakumachi 2-7, Takatsuki, Osaka 569-8686 Japan
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54
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Persistent left superior vena cava, absent right superior vena cava and coronary-bronchial fistula: The good, the bad and the ugly (case report and review of literature). COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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55
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Daruwalla VJ, Parekh K, Tahir H, Collins JD, Carr J. Raghib Syndrome Presenting as a Cryptogenic Stroke: Role of Cardiac MRI in Accurate Diagnosis. Case Rep Cardiol 2015; 2015:921247. [PMID: 26106490 PMCID: PMC4461698 DOI: 10.1155/2015/921247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/15/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022] Open
Abstract
Raghib Syndrome is a rare developmental complex, which consists of persistence of the left superior vena cava (PLSVC) along with coronary sinus ostial atresia and atrial septal defect. This Raghib complex anomaly has also been associated with other congenital malformations including ventricular septal defects, enlargement of the tricuspid annulus, and pulmonary stenosis. Our case demonstrates an isolated PLSVC draining into the left atrium along with coronary sinus atresia in a young patient presenting with cryptogenic stroke without the atrial septal defect. Majority of the cases reported in the literature were found to have the lesion during the postmortem evaluation or were characterized at angiography and/or echocardiography. We stress the importance of modern day imaging like the computed tomography (CT) angiography and cardiac MRI in diagnosis and surgical management of such rare lesions leading to cryptogenic strokes.
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Affiliation(s)
| | - Keyur Parekh
- Department of Cardiovascular Radiology, Northwestern University Feinberg School of Medicine, USA
| | - Hassan Tahir
- Conemaugh Memorial Hospital/Temple University, USA
| | - Jeremy D. Collins
- Department of Cardiovascular Radiology, Northwestern University Feinberg School of Medicine, USA
| | - James Carr
- Department of Cardiovascular Radiology, Northwestern University Feinberg School of Medicine, USA
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56
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Ruano CA, Marinho-da-Silva A, Donato P. Congenital Thoracic Venous Anomalies in Adults: Morphologic MR Imaging. Curr Probl Diagn Radiol 2015; 44:337-45. [PMID: 25953438 DOI: 10.1067/j.cpradiol.2015.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 11/22/2022]
Abstract
Congenital anomalies of the thoracic veins are rare yet important developmental abnormalities, usually classified into systemic and pulmonary. They may be encountered incidentally; as such the radiologist must be aware of their imaging presentation and clinical relevance. Furthermore, to understand these anomalies, knowledge of the embryological development and of the normal anatomy of the thoracic veins is required. In the age of non-invasive imaging modalities, magnetic resonance is paramount for the characterization of these developmental abnormalities.
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Affiliation(s)
- Carina A Ruano
- Department of Radiology, Central Lisbon Hospital Centre, Lisbon, Portugal.
| | | | - Paulo Donato
- Department of Radiology, Coimbra Hospital and University Centre, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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57
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Korantzopoulos P, Kolios M, Nikas D, Goudevenos JA. Implantable cardioverter defibrillator lead placement in the right ventricular outflow tract in a patient with Brugada syndrome and persistent left superior vena cava. Int J Cardiol 2015; 181:166-8. [PMID: 25497546 DOI: 10.1016/j.ijcard.2014.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Marios Kolios
- 1st Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - Dimitrios Nikas
- 1st Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
| | - John A Goudevenos
- 1st Department of Cardiology, University of Ioannina Medical School, Ioannina, Greece
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58
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Kim H, Kim JH, Lee H. Persistent left superior vena cava: diagnosed by bedside echocardiography in a liver transplant patient: a case report. Korean J Anesthesiol 2015; 67:429-32. [PMID: 25558346 PMCID: PMC4280483 DOI: 10.4097/kjae.2014.67.6.429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Revised: 01/07/2014] [Accepted: 01/08/2014] [Indexed: 11/29/2022] Open
Abstract
In most cases, persistent left superior vena cava (PLSVC) is asymptomatic and discovered accidentally. This case involves a 43-year-old male who underwent an emergency cadaveric liver transplantation. Postoperatively, the left internal jugular vein was cannulated using a sono-guided Seldinger technique in the intensive care unit. But the chest X-ray showed that the catheter followed the left paramediastinal course instead of crossing midline to the right to enter the superior vena cava. In consideration of the patient's status, an intra-arterial or extra-vascular placement could be excluded. For a diagnosis, we performed a bed-side transthoracic echocardiography with an agitated saline micro-bubble test. When agitated saline was injected through the catheter, the coronary sinus was initially opacified, and then the right atrium followed. In conclusion, we were able to make a diagnosis of PLSVC by a bedside test without radiation exposure.
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Affiliation(s)
- Hyerim Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jin Hee Kim
- Department of Anesthesiology and Pain Medicine, National University Bundang Hospital, Seongnam, Korea
| | - Hannah Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
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59
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Mousa TM, Akinseye OA, Kerwin TC, Akinboboye OO. A Rare Association of Sinus Venosus-Type Atrial Septal Defect and Persistent Left Superior Vena Cava Detected by Transthoracic Echocardiography and Cardiac Magnetic Resonance Imaging. Am J Case Rep 2015; 16:528-31. [PMID: 26262994 PMCID: PMC4536868 DOI: 10.12659/ajcr.894394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tarek M. Mousa
- Department of Cardiology, Queens Heart Institute, Laurelton, NY, USA
| | - Oluwaseun A. Akinseye
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, Jamaica, NY, USA
| | - Todd C. Kerwin
- Department of Cardiology, The New York Hospital Medical Center of Queens/Cornell University Medical College, Flushing, NY, USA
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Nair GM, Shen S, Nery PB, Redpath CJ, Birnie DH. Cardiac Resynchronization Therapy in a Patient with Persistent Left Superior Vena Cava Draining into the Coronary Sinus and Absent Innominate Vein: A Case Report and Review of Literature. Indian Pacing Electrophysiol J 2014; 14:268-72. [PMID: 25408568 PMCID: PMC4217305 DOI: 10.1016/s0972-6292(16)30799-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Persistent left superior vena cava (PLSVC) is a rare congenital anomaly of the superior venous system that may be discovered at the time of cardiac implantable electronic device (CIED) implantation. Methods and Results We present a subject who needed cardiac resynchronization therapy (CRT)-CIED implantation and was discovered to have PLSVC with absent innominate vein during the implant procedure. We were able to successfully implant a CRT-CIED using a right-sided approach via the right superior vena cava (SVC). We present a description of our implant technique and a brief review of the different aspects of CIED implantation in subjects with variants of PLSVC. Conclusion Superior venous anomalies such as PLSVC can make CIED implantation technically challenging. However, with increasing operator experience, cardiac imaging and appropriate tools successful CIED implantation is possible in almost all cases.
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61
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Zani A, Becchetti E, Leonardi P, Sinatra A. Persistent left cranial vena cava draining into the left atrium associated with pulmonary stenosis in a French bulldog. J Vet Cardiol 2014; 16:121-5. [DOI: 10.1016/j.jvc.2014.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 03/05/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
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62
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Placido R, Sousa J, Marques P. CRT-D Implantation Through a Persistent Left Superior Vena Cava. Indian Pacing Electrophysiol J 2014; 14:165-6. [PMID: 24920873 PMCID: PMC4032785 DOI: 10.1016/s0972-6292(16)30759-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Rui Placido
- Hospital Santa Maria, Serv Cardiologia I, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal
| | - Joao Sousa
- Hospital Santa Maria, Serv Cardiologia I, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal
| | - Pedro Marques
- Hospital Santa Maria, Serv Cardiologia I, Lisbon Academic Medical Centre, CCUL, Lisbon, Portugal
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63
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Mora G. A novel method of placing right ventricular leads in patients with persistent left superior vena cava using a conventional j stylet. Indian Pacing Electrophysiol J 2014; 14:65-74. [PMID: 24669104 PMCID: PMC3951613 DOI: 10.1016/s0972-6292(16)30731-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Locating pacemaker electrodes can become complicated by congenital abnormalities such as persistent left superior vena cava (LSVC). OBJECTIVE To evaluate a technique for the implanting of ventricular electrode in patients with persistent LSVC. MATERIALS AND METHODS The study was carried out from June 2001 to June 2010 involving all patients who were admitted to the Hospital Universitario Mayor, Instituto de Corazon de Bogota and Hospital Universitario Clinica San Rafael (Bogota-Colombia) for implanting pacemakers or cardiac defibrillators. LSVC was diagnosed by fluoroscopic observation (anterior-posterior view) of the course of the stylet. Four steps were followed: 1) Move the electrode with a straight stylet to the right atrium. 2) Change the straight stylet by a conventional J stylet and push the electrode to the lateral or anterolateral wall of the right atrium. 3) Remove the guide 3-5 cm and 4) Push the electrode which crosses the tricuspid valve into the right ventricle and finally deploy the active fixation mechanism. RESULTS A total of 1198 patients were admitted for pacemaker or cardiac defibrillator implant during the 9-year study period, 1114 received a left subclavian venous approach. There were 573 males and 541 females. Persistent LSVC was found in five patients (0.45%) Fluoroscopy time for implanting the ventricular electrode ranged from 60 to 250 seconds, 40 to 92 minutes being taken to complete the whole procedure. CONCLUSION We present a simple and rapid technique for electrode placement in patients with LSVC using usual J guide and active fixation electrodes with high success.
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64
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Seemann M, Zech N, Kieninger M, Graf B, Künzig H. [Placement of a central venous catheter in cases of persistent left superior vena cava]. Anaesthesist 2014; 63:231-3. [PMID: 24566941 DOI: 10.1007/s00101-014-2304-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 01/20/2014] [Accepted: 01/26/2014] [Indexed: 11/25/2022]
Abstract
This article presents a case report on the placement of a central venous catheter (CVC) in a patient with an unknown persistent left superior vena cava (PLSVC). Normally, PLSVCs remain asymptomatic but can be associated with disastrous consequences for the patient during placement of a CVC particularly due to vascular perforation and pulmonary injury. A PLSCV is particularly common in association with congenital heart defects; however, otherwise healthy patients can also be affected. As the presence of a PLSCV is normally unknown special attention must be paid in every patient during placement of a CVC.
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Affiliation(s)
- M Seemann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland
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65
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Sheikh AS, Mazhar S. Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava: Review of the Literature and Clinical Implications. Echocardiography 2014; 31:674-9. [DOI: 10.1111/echo.12514] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Azeem S. Sheikh
- Southend University Hospital; NHS Foundation Trust; Westcliff-on-Sea Essex United Kingdom
| | - Sajjad Mazhar
- Southend University Hospital; NHS Foundation Trust; Westcliff-on-Sea Essex United Kingdom
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66
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Rajakulasingam R, Francis R, Rajakulasingam R. Vena caval anomalies. J Clin Imaging Sci 2013; 3:51. [PMID: 24404410 PMCID: PMC3883268 DOI: 10.4103/2156-7514.122319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/02/2013] [Indexed: 12/02/2022] Open
Abstract
Anomalous vena cavae can have significant implications for procedures on the right side of the heart. We report a rare anatomical configuration in a 44-year-old female, which to the best of our knowledge, is the first report of such an association. She had a bicuspid aortic valve in conjunction with a persistent left superior vena cava (PLSVC) draining into the coronary sinus, and a left-sided inferior vena cava (IVC) draining into a left superior vena cava via the hemiazygos vein. Comprehensive assessment of these anomalies is crucial given the widespread use of invasive cardiac procedures.
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Affiliation(s)
- Ramyah Rajakulasingam
- Department of Cardiology, East and North Hertfordshire NHS Trust, United Kingdom ; Lister Hospital, East and North Hertfordshire NHS Trust, United Kingdom
| | - Rohin Francis
- Lister Hospital, East and North Hertfordshire NHS Trust, United Kingdom
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67
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Perles Z, Nir A, Gavri S, Golender J, Tashma A, Ergaz Z, Rein AJJT. Prevalence of persistent superior vena cava and association with congenital heart anomalies. Am J Cardiol 2013; 112:1214-8. [PMID: 23890574 DOI: 10.1016/j.amjcard.2013.05.079] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/31/2013] [Accepted: 05/31/2013] [Indexed: 11/19/2022]
Abstract
A contralateral persistent superior vena cava (PSVC) can occur in a normal child or in association with congenital heart defects (CHDs). Its prevalence has been demonstrated in relatively small cohorts. We aim to assess the frequency of a PSVC in a large cohort of children with and without CHDs. To estimate its significance, we have searched for a PSVC in all children referred for echocardiography in our institution during a 16.5-year period. A group of 17,219 children comprised 8,140 children with a structural heart anomaly and 9,079 children with a structurally normal heart. Association between a PSVC and specific classes of CHD were looked for. A total of 288 children (1.7%) had a PSVC; 0.56% (51 of 9,079) in the normal heart group and 2.9% (237 of 8,140) in the congenital heart anomalies group. Odds ratio for having heart anomaly in the presence of PSVC was 5.2 (95% confidence interval 3.7 to 7.0). A PSVC was above all associated with atrioventricular septal defects, conotruncal malformations, and left-sided defects. The odds ratio of having PSVC in the aforementioned malformations compared with the normal heart group was 23.8, 13.6, and 11.0, respectively. In conclusion, although present in normal subjects, PSVC was more often associated with congenital heart and other anomalies, especially with atrioventricular septal defects, conotruncal malformations, and left-sided defects.
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Affiliation(s)
- Zeev Perles
- Department of Pediatric Cardiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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68
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Eldin GS, El-Segaier M, Galal MO. High prevalence rate of left superior vena cava determined by echocardiography in patients with congenital heart disease in Saudi Arabia. Libyan J Med 2013; 8:21679. [PMID: 24107708 PMCID: PMC3794077 DOI: 10.3402/ljm.v8i0.21679] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/13/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Persistent left superior vena cava (LSVC) is one of the common anomalies of the systemic veins. Its prevalence is 0.1-0.3% in the general population and is more common with congenital heart disease (CHD). The importance of detecting persistent LSVC prior to cardiac surgery is paramount for systemic veins cannulations. AIM The aim was to evaluate the prevalence of persistent LSVC in patients with CHD in Saudi Arabia. METHODS All patients referred to our institution had echocardiography. All complete studies were reviewed for the presence of persistent LSVC. A computerized database was created including the demographic data, CHD diagnoses, and the presence of persistent LSVC. RESULTS A total of 2,042 were examined with an age range of 1 day to 16 years. The complete echocardiographic studies were 1,832 (90%) of whom 738 (40%) patients had CHD. The prevalence of persistent LSVC in patients with CHD was 7.8% (OR 9.26, 95% CI 4.7-18.2, p<0.001). The most common cardiac defect associated with persistent LSVC was complete atrioventricular septal defect (AVSD); all patients with AVSD had Down syndrome. The total number of patients with AVSD was 41, and persistent LSVC was found in 11 (26%) of them (odds ratio 5.1, 95% CI 2.4-10.8, p<0.001). CONCLUSIONS The prevalence of persistent LSVC in the current population is almost double the reported prevalence obtained using the same echocardiographic screening tool.
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Affiliation(s)
- Ghada Shiekh Eldin
- Department of Paediatric Cardiology, PSHC, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Milad El-Segaier
- Department of Paediatric Cardiology, PSHC, King Fahd Medical City, Riyadh, Saudi Arabia
- Department of Paediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Mohammed Omer Galal
- Department of Paediatric Cardiology, PSHC, King Fahd Medical City, Riyadh, Saudi Arabia
- Department of Paediatric Cardiology, University of Essen, Essen, Germany
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69
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Menachem JN, Sundaram SN, Rhodes JF. Recurrent cerebral abscess secondary to a persistent left superior vena cava. CONGENIT HEART DIS 2013; 9:E78-84. [PMID: 23710652 DOI: 10.1111/chd.12081] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/17/2013] [Indexed: 11/30/2022]
Abstract
Cerebral abscess is a serious neurological condition that is often of unclear etiology. Management is usually medical therapy with or without direct drainage, and when patients have recurrent episodes a structural abnormality should be considered. Persistent left superior vena cava is an uncommon condition in the absence of other forms of congenital heart disease. This venous connection most often enters the right-sided atrium through the coronary sinus but occasionally can connect directly to the left atrium near the wall between the orifice of the left pulmonary veins and left atrial appendage. This later congenital connection results in systemic venous return entering the left atrium directly. Thus allowing unfiltered, lower saturation blood entering the systemic system. This then places the patient at risk for systemic hypoxemia, paradoxical embolic events, and cerebral abscess. In our case report with recurrent cerebral abscess and a persistent left superior vena cava, we demonstrate when to consider this diagnosis, how to make the diagnosis, and a nonsurgical approach to repair the veno-atrial shunt.
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70
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Vijayvergiya R, Shrivastava S, Kumar A, Otaal PS. Transvenous defibrillator implantation in a patient with persistent left superior vena cava. World J Cardiol 2013; 5:109-111. [PMID: 23675558 PMCID: PMC3653011 DOI: 10.4330/wjc.v5.i4.109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 11/28/2012] [Accepted: 03/09/2013] [Indexed: 02/06/2023] Open
Abstract
Persistent left superior vena cava (LSVC) can be incidentally detected during pacemaker implantation through left pectoral side. There is technical difficulty of optimal site pacing and lead stability for right ventricle lead in such situation. We hereby report a case of successful single-chamber implantable cardioverter defibrillator (ICD) implantation in a 50 years-old male with LSVC. The practical issues related with right ventricle lead implantation and pacing/defibrillation parameters for ICD device are discussed.
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71
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Kim DH, Park SJ, Jung JW, Kim NK, Choi JY. Transcatheter treatment of patent foramen ovale combined with abnormal drainage of left superior vena cava to left upper pulmonary vein. J Cardiovasc Ultrasound 2013; 21:33-6. [PMID: 23560142 PMCID: PMC3611118 DOI: 10.4250/jcu.2013.21.1.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 12/27/2012] [Accepted: 02/13/2013] [Indexed: 11/22/2022] Open
Abstract
Patent foramen ovale (PFO) has been known to be the cause of transient ischemic attacks or stroke, and transcatheter device closure has been the treatment of choice for these defects. Combined defect of abnormal drainage of left superior vena cava (LSVC) to left superior pulmonary vein (LSPV) in PFO patients is an uncommon combination, and both can act as a pathway for paradoxical embolism. We report a successful closure of PFO, using Amplatzer® PFO occluder (St. Jude Medical, St. Paul, MN, USA) and persistent LSVC connected to LSPV using an Amplatzer® Vascular Plug II (St. Jude Medical, St. Paul, MN, USA). Because this combined anomaly of PFO and persistent LSVC can be treated by a single transcatheter intervention, if clinically suspected, a complete evaluation for this anomaly should be considered.
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Affiliation(s)
- Do Hoon Kim
- Division of Pediatric Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea
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72
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Persistent left superior vena cava. Report of 3 patients undergoing device implantation. Herz 2013; 39:163-5. [PMID: 23558554 DOI: 10.1007/s00059-013-3797-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 03/03/2013] [Indexed: 02/06/2023]
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73
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Petrac D, Radeljic V, Pavlovic N, Manola S, Delic-Brkljacic D. Persistent Left Superior Vena Cava in Patients Undergoing Cardiac Device Implantation: Clinical and Long-Term Data. Cardiol Res 2013; 4:64-67. [PMID: 28352422 PMCID: PMC5358215 DOI: 10.4021/cr267w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2013] [Indexed: 11/05/2022] Open
Abstract
Background Persistent left superior vena cava (LSVC) is a rare congenital venous anomaly that may be found at the time of cardiac device lead insertion. Methods In this case series, we present clinical and long-term data of five patients with LSVC who underwent pacemaker (PM) or cardioverter defibrillator (ICD) implantation during the period of 10 years. Results Left-sided venous approach was used for device implantation in 3 patients with standard PM indications, whereas a right-sided venous approach and an epicardial approach had to be used in 2 patients who needed an ICD and biventricular PM, respectively. In post implantation period of 44 ± 29 months, one patient died due to stroke, one underwent heart transplantation, and 3 had atrial fibrillation. Conclusion The long-term outcome of patients with persistent LSVC and implanted cardiac devices is mostly influenced by the presence of underlying heart disease.
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Affiliation(s)
- Dubravko Petrac
- Department of Cardiology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Vjekoslav Radeljic
- Department of Cardiology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Nikola Pavlovic
- Department of Cardiology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Sime Manola
- Department of Cardiology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Diana Delic-Brkljacic
- Department of Cardiology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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74
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Porcellini S, Rimini A, Biasi S. Pacemaker implantation in a patient with persistent left superior vena cava using a steerable catheter-delivered lead. J Cardiovasc Med (Hagerstown) 2013; 13:653-5. [PMID: 20308913 DOI: 10.2459/jcm.0b013e3283389aff] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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75
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Kobayashi T, Yagi T, Okazaki Y, Jinbo M, Saito S, Takahashi T, Gohra H. Mitral valve repair in patient with absent right superior vena cava in visceroatrial situs solitus. J Cardiothorac Surg 2013; 8:9. [PMID: 23317475 PMCID: PMC3560078 DOI: 10.1186/1749-8090-8-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 01/11/2013] [Indexed: 11/16/2022] Open
Abstract
We report on a 74-year-old woman with an absence of right superior vena cava in visceroatrial situs solitus who underwent mitral valve plasty for severe mitral regurgitation. Preoperative three-dimensional computed tomography revealed an absent right and persistent left superior vena cava that drained into the right atrium by way of the coronary sinus. Perioperaively, placement of pulmonary artery catheter, site of venous cannulation, and management of associated rhythm abnormalities were great concern. Obtaining the information about this central venous malformation preoperatively, we performed mitral valve plasty without any difficulties related to this anomaly.
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Affiliation(s)
- Toshiro Kobayashi
- Departments of Surgery, Saiseikai Yamaguchi General Hospital, 2-11 Midori-Cho, Yamaguchi, Yamaguchi 753-0078, Japan.
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76
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Seow SC, Agbayani MF, Lim TW, Kojodjojo P. Left ventricular pacing in persistent left superior vena cava: a case series and potential application. ACTA ACUST UNITED AC 2013; 15:845-8. [DOI: 10.1093/europace/eus417] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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77
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Yoshida M, Hino H, Machida H, Hatakeyama N, Okano Y, Iwahara Y, Shinohara T, Oogushi F. Cancer of the left lung with persistent left superior vena cava. Ann Thorac Surg 2012; 94:1326-8. [PMID: 23006688 DOI: 10.1016/j.athoracsur.2012.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 02/15/2012] [Accepted: 03/01/2012] [Indexed: 10/27/2022]
Abstract
As operations for lung cancer become more common, more anomalies of various pulmonary arteries and veins are being encountered. Persistent left superior vena cava (PLSVC) is caused by abnormal development of the sinus venosus in early fetal life. In cases of PLSVC with left lung cancer, particular care must be exercised during the excision of the pulmonary vein, focusing on the region into which the PLSVC flows. In such anomalous cases, proper excision of the pulmonary artery and vein and lymph node dissection require a firm grasp of anatomic detail using preoperative computed tomographic scanning.
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Affiliation(s)
- Mitsuteru Yoshida
- Department of Thoracic, Endocrine Surgery and Oncology, Institute of Health Bioscience, University of Tokushima Graduate School, Tokushima, Japan.
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78
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Schwartz RH, Neacsu O, Ascher DP, Alpan O. Moderate dose inhaled corticosteroid-induced symptomatic adrenal suppression: case report and review of the literature. Clin Pediatr (Phila) 2012; 51:1184-90. [PMID: 23043135 DOI: 10.1177/0009922812462235] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inhaled corticosteroids (ICS) are drugs of choice for persistent asthma. Less than 500 µg/d of fluticasone are believed to be safe. We found 92 cases of adrenal suppression in PubMed; among these cases there were 13 children who took 500 µg/d or less of fluticasone. Adrenal insufficiency was diagnosed in a 7-year-old boy on 460 µg ICS for 16 months, with a diagnosis of chronic persistent asthma. A random cortisol was nondetectable as was an early morning cortisol. ICS have greatly improved the day-to-day lives of children with chronic persistent asthma. Parents of children younger than 12 years, who use at least 400 µg of inhaled fluticasone (or bioequivalent), must be given oral and written instructions about warning symptoms of hypocortisolism. Major stress such as surgery, gastrointestinal, bronchopulmonary, or other systemic infections, and heat stress may mandate a written plan of action for use by hospital physicians.
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79
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Lupattelli T, Benassi F, Righi E, Bavera P, Bellagamba G. Percutaneous transluminal angioplasty in a patient with chronic cerebrospinal venous insufficiency and persistent left superior vena cava. Phlebology 2012; 29:200-2. [PMID: 23155131 DOI: 10.1258/phleb.2012.012040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses of the internal jugular veins (IJVs) and/or azygos veins and formation of collateral venous channels. A case of a 57-year-old patient with CCSVI in whom the venous outflow from the left IJV to the right atrium occurred through a venous anomaly, the persistent left superior vena cava (PLSVC), is reported. PLSVC is caused by persistence of the left anterior cardinal vein that drains blood from the limb effluent from the left and the left side of head and neck into coronary sinus (Type a), or in the left atrium (Type b). PLSVC can be associated either with innominate vein hypoplasia or other congenital heart abnormalities. Because of evidence of left innominate vein hypoplasia, angioplasty was not performed using the ordinary route but passing with the balloon directly through the PLSVC up to the left IJV. Finally, angioplasty was carried out in a standard manner in the right IJV as well as in the azygous vein. Confirmation angiogram revealed complete reopening of all treated vessels with no evidence of peri- and postoperative complications. The patient was discharged home the following day in good general conditions. PLSVC is a rare congenital vein anomaly but in case of concomitant innominate vein hypoplasia may prove to be a valuable alternative to treat patients with IJV diseases.
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Affiliation(s)
- T Lupattelli
- Department of Interventional Radiology, ICC Sanità, via alessandro Magno 386, Rome 00100
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80
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Tracking the path traversed by temporary pacing lead. Indian Heart J 2012; 64:524-6. [PMID: 23102396 DOI: 10.1016/j.ihj.2012.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 06/11/2012] [Accepted: 07/17/2012] [Indexed: 11/24/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) results from abnormal development of the sinus venosus in the early stages of fetal life. Though there are numerous reports of successful permanent pacemaker implants in such cases, placement of permanent pacing leads in such cases is technically challenging, often requiring shaping of stylets and considerable lead maneuvering. We describe an interesting case wherein a temporary pacemaker lead after entering the PLSVC followed an unusual fluoroscopic course with demonstrable pacing in right ventricle (RV), right atrium (RA) and the left ventricle (LV). Interventional cardiologists and intensivists performing pacing procedures need to be aware that one may rarely encounter such interesting radiographic and electrocardiographic patterns in these cases with anomalous systemic venous drainage.
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81
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Cardiac resynchronization therapy for patients with congenital heart disease: technical challenges. J Interv Card Electrophysiol 2012; 36:71-9. [DOI: 10.1007/s10840-012-9726-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Accepted: 09/03/2012] [Indexed: 11/30/2022]
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82
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Guenther M, Kolschmann S, Rauwolf TP, Christoph M, Sandfort V, Strasser RH, Wunderlich C. Implantable cardioverter defibrillator lead implantation in patients with a persistent left superior vena cava--feasibility, chances, and limitations: representative cases in adults. Europace 2012; 15:273-7. [PMID: 22997221 DOI: 10.1093/europace/eus287] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Device implantation may be challenging in patients with venous abnormalities. The most common congenital variation--frequently associated with other congenital abnormalities--is described as persistent left superior vena cava (PLSVC). METHODS AND RESULTS The present case series demonstrates successful implantable cardioverter defibrillator (ICD) lead implantation in the most common anatomic variations of PLSVC. All types of current ICD models (single and dual chamber, VDD, and cardiac resynchronization therapy devices) were used. Angiographic findings and implantation techniques (e.g. guiding and diagnostic catheters, wires, occlusion balloons, and rotation sequences) are presented in images and movie sequences. CONCLUSION Device implantation in patients with PLSVC may be complex but a successful transvenous approach is possible in most of the cases. Careful imaging prior to implantation procedure is essential for understanding the individual anatomy and in order to choose adequate material and implantation strategy.
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Affiliation(s)
- M Guenther
- Department of Internal Medicine and Cardiology, University of Dresden, Heart Center, University Hospital, Fetscherstraße 76, 01307 Dresden, Germany
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83
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Kubota S, Nakano K, Kodera K, Asano R, Kataoka G, Tatsuishi W. Mitral valve plasty in an adult patient without a right superior vena cava. Gen Thorac Cardiovasc Surg 2012; 60:569-71. [PMID: 22945860 DOI: 10.1007/s11748-012-0001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Accepted: 04/15/2011] [Indexed: 11/28/2022]
Abstract
Persistent left superior vena cava without a right superior vena cava is an extremely rare condition. We report the case of a 65-year-old woman with this condition who underwent mitral valve plasty. During cardiac catheterization, the asymptomatic patient with mitral valve prolapse syndrome was found to have a persistent left superior vena cava without a right superior vena cava. During mitral valve plasty, cardiopulmonary bypass was established using bicaval drainage through the persistent left superior vena cava and the right atrium. A cannula was inserted into the persistent left superior vena cava to provide a large surgical field in the left atrium. We selected a technique that involved direct insertion of an L-shaped cannula into the persistent left superior vena cava and obtained a clear view of the surgical field. Proper assessment of the right superior vena cava is necessary when a persistent left superior vena cava is suspected.
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Affiliation(s)
- Sayaka Kubota
- Department of Cardiovascular Surgery, Tokyo Women's Medical University, Medical Center East, Nishiogu 2-1-10, Arakawa-Ku, Tokyo 116-8567, Japan.
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84
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Providência R, Paiva LV, Cação R, Mota P. Perforation of the right ventricle during cardiac resynchronisation therapy upgrade not related to a coexisting persistent left superior vena cava. BMJ Case Rep 2012; 2012:bcr-2012-006299. [PMID: 22922915 DOI: 10.1136/bcr-2012-006299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Right ventricle (RV) perforation is a complication that may arise during device implants. We present the case of a patient undergoing cardiac resynchronisation therapy upgrade that was complicated with an RV perforation. The lead was successfully repositioned with a good final outcome. Despite being uncommon, persistence of the left superior vena cava is the most frequent venous cardiac anomaly and may pose challenges during the implant procedure, namely when the right superior vena cava (RSVC) is absent. Still, in this patient it was not related to the event, as the leads were advanced through the RSVC.
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Affiliation(s)
- Rui Providência
- Department of Cardiology, Coimbra's Hospital Centre and University, S. Martinho do Bispo, Coimbra, Portugal.
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85
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Williams TA, Abe O, Mitre CA, Kassotis J. Low defibrillation threshold in a patient with a dual-coil defibrillator lead implanted through a persistent left superior vena cava. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:e274-5. [PMID: 22650311 DOI: 10.1111/j.1540-8159.2012.03432.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several reports have described the successful insertion of implantable cardioverter defibrillator (ICD) in patients with a persistent left superior vena cava (PLSVC). The implanters have used various techniques to achieve appropriate lead placement. In our case, the use of a long sheath, guided by a deflectable catheter, not only facilitated proper implantation of the lead, but also provided a unique position of the dual-coil lead. This resulted in a very low defibrillation threshold (DFT). We describe a case of a patient found to have a PLSVC at implant who after successful insertion of the ICD exhibited DFT ≤ 5 J.
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Affiliation(s)
- Thomas A Williams
- Department of Electrophysiology, SUNY Downstate Medical Center, Brooklyn, New York, USA
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86
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Aperis G, Paliouras C, Moschos N, Tsampikaki E, Alivanis P. SLOW CONTINUOUS ULTRAFILTRATION IN A PATIENT WITH ANOMALY OF A PERSISTENT LEFT SUPERIOR VENA CAVA. J Ren Care 2012; 38:151-4. [DOI: 10.1111/j.1755-6686.2012.00256.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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87
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Kumar S, Moorthy N, Kapoor A, Sinha N. A challenging dual chamber permanent pacemaker implantation in persistent left superior vena cava with absent right superior vena cava. J Cardiol Cases 2012; 5:e122-e124. [PMID: 30532919 DOI: 10.1016/j.jccase.2011.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 11/21/2011] [Accepted: 12/06/2011] [Indexed: 11/16/2022] Open
Abstract
An isolated persistent left superior vena cava (PLSVC) with absent right superior vena cava is a rare and generally asymptomatic congenital malformation. It is usually discovered incidentally during a pacemaker implantation or electrophysiological procedures. We report an adult male who underwent successful dual chamber permanent pacemaker implantation through left subclavian approach with a 7-year follow-up showing a still appropriate function of the device. We discuss the technical issues and solutions to overcome such technical difficulties.
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Affiliation(s)
- Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nagaraja Moorthy
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Nakul Sinha
- Department of Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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88
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Weymann A, Schmack B, Karck M, Szabo G. Orthotopic Heart Transplantation in a Patient with Persistent Left Superior Vena Cava. Ann Thorac Cardiovasc Surg 2012; 18:554-6. [DOI: 10.5761/atcs.cr.11.01828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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89
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Povoski SP, Khabiri H. Persistent left superior vena cava: review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients. World J Surg Oncol 2011; 9:173. [PMID: 22204758 PMCID: PMC3266648 DOI: 10.1186/1477-7819-9-173] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 12/28/2011] [Indexed: 12/11/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) represents the most common congenital venous anomaly of the thoracic systemic venous return, occurring in 0.3% to 0.5% of individuals in the general population, and in up to 12% of individuals with other documented congential heart abnormalities. In this regard, there is very little in the literature that specifically addresses the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians actively involved in central venous access device placement in cancer patients. In the current review, we have attempted to comprehensively evaluate the available literature regarding PLSVC. Additionally, we have discussed the clinical implications and relevance of such congenital aberrancies, as well as of treatment-induced or disease-induced alterations in the anatomy of the thoracic central venous system, as they pertain to the general principles of successful placement of central venous access devices in cancer patients. Specifically regarding PLSVC, it is critical to recognize its presence during attempted central venous access device placement and to fully characterize the pattern of cardiac venous return (i.e., to the right atrium or to the left atrium) in any patient suspected of PLSVC prior to initiation of use of their central venous access device.
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Affiliation(s)
- Stephen P Povoski
- Division of Surgical Oncology, Department of Surgery, Arthur G, James Cancer Hospital and Richard J, Solove Research Institute and Comprehensive Cancer Center, The Ohio State University Medical Center, Columbus, Ohio 43210, USA.
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90
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Successful implantation of a permanent pacemaker through a persistent left superior vena cava by using a right subclavian approach. VOJNOSANIT PREGL 2011; 68:792-4. [PMID: 22046886 DOI: 10.2298/vsp1109792j] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Persistent left superior vena cava, a rare congenital abnormality, can complicate placement of pacemaker leads through the subclavian vein. A left-sided approach is usually preferable in such cases. CASE REPORT We reported a case in which we began a single-chamber pacemaker implantation procedure via a right subclavian approach (because of scarring beneath the left clavicle) and then discovered intraoperatively that the patient had a persistent left superior vena cava. After a few attempts, we succeeded in placing the head of the electrode in the septum, near the top of the right ventricle, and the rest of the procedure was completed without complication. CONCLUSION To our knowledge, this is the first reported case of pacemaker implantation, with passive electrode, through a persistent left superior vena cava via the right subclavian vein. This case demonstrates that such an approach, when necessary, can be used successfully.
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91
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Shoemaker MB, Rottman JN. Conductor extrusion in a persistent left superior vena cava. Europace 2011; 14:307. [PMID: 22186776 DOI: 10.1093/europace/eur380] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Moore Benjamin Shoemaker
- Division of Cardiovascular Medicine, Nashville VA Medical Center and Vanderbilt University, School of Medicine, Nashville, TN 37232-8802, USA.
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Prevalence of associated cardiovascular abnormalities in 500 patients with aortic coarctation referred for cardiovascular magnetic resonance imaging to a tertiary center. Pediatr Cardiol 2011; 32:1120-7. [PMID: 21512788 DOI: 10.1007/s00246-011-9981-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/22/2011] [Indexed: 10/18/2022]
Abstract
Coarctation of the aorta (CoA) is a common congenital defect whose overall incidence is 5-8% of all congenital cardiac anomalies. Associated cardiac anomalies have been well described in previous studies examining specific subgroups of CoA patients, particularly infants and necropsy specimens. The majority of studies, conducted from the 1970s to 1980s, excluded older children, adolescents, and adults. Given the advent of improved surgical and interventional techniques, many CoA patients are surviving into adulthood. This study examined a population of 500 CoA patients in the authors' cardiovascular magnetic resonance imaging (MRI) database involving a population of CoA survivors 5-79 years of age. This was to give a new perspective on the prevalence of associated cardiovascular abnormalities including the bicuspid aortic valve, arch hypoplasia, intracardiac shunts, and subaortic stenosis. These associated abnormalities are less prevalent than in previous studies, reflecting a milder spectrum of CoA. Cardiovascular MRI with its multiplanar imaging capabilities and lack of ionizing radiation is safe and suitable for evaluation and follow-up assessment of CoA patients. Evaluation of CoA by MRI should not be confined to the arch, but should include the heart and mediastinal vessels to assess for the presence and severity of any expected or unexpected associated anomalies.
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93
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Kurtoglu E, Cakin O, Akcay S, Akturk E, Korkmaz H. Persistent Left Superior Vena Cava Draining into the Coronary Sinus: A Case Report. Cardiol Res 2011; 2:249-252. [PMID: 28357015 PMCID: PMC5358287 DOI: 10.4021/cr85w] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2011] [Indexed: 12/04/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a congenital anomaly of the thoracic venous system resulting from the abnormal persistence of an embryological vessel that normally regresses during early fetal life. This anomaly is often discovered incidentally during surgery, cardiovascular imaging or invasive cardiovascular procedures. In most cases, a PLSVC drains into the right atrium through the coronary sinus. In the remainder of cases, it enters directly or through the pulmonary veins into the left atrium. A dilated coronary sinus on echocardiography should always raise the suspicion of a PLSVC as it has important clinical implications. The diagnosis should be confirmed by saline contrast echocardiography. We report a patient with persistent left superior vena cava with an enlarged coronary sinus and normal right superior vena cava.
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Affiliation(s)
- Ertugrul Kurtoglu
- Elazig Training and Research Hospital, Clinic of Cardiology, Elazig, Turkey
| | - Ozlem Cakin
- Harput State Hospital, Clinic of Internal Medicine, Elazig, Turkey
| | | | - Erdal Akturk
- Adiyaman University, Department of Cardiology, Adiyaman, Turkey
| | - Hasan Korkmaz
- Elazig Training and Research Hospital, Clinic of Cardiology, Elazig, Turkey
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Mitov V, Perišić Z, Jolić A, Kostić T, Nikolić D, Aleksić A. TEMPORARY PACEMAKER LEAD PLACEMENT IN PATIENT WITH PERSISTENT LEFT SUPERIOR VENA CAVA. ACTA MEDICA MEDIANAE 2011. [DOI: 10.5633/amm.2011.0310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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95
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Congenital Thoracic Vascular Anomalies: Evaluation with State-of-the-Art MR Imaging and MDCT. Radiol Clin North Am 2011; 49:969-96. [DOI: 10.1016/j.rcl.2011.06.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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96
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Pereira R, Faber C, Caldeira C. Orthotopic heart transplantation in patients with persistent left superior vena cava and agenesis of left brachiocephalic vein. J Card Surg 2011; 26:446-8. [PMID: 21793934 DOI: 10.1111/j.1540-8191.2011.01268.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Persistent left superior vena cava (PLSVC) is an infrequent abnormality. Anatomical variations can be unexpectedly identified during cardiac procedures. Modifications of surgical techniques become a must during these operations, especially during orthotopic heart transplantation. We present two cases of patients with PLSVC and discuss the anatomy, embryology, diagnosis, and modifications in transplant techniques.
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Affiliation(s)
- Raiane Pereira
- Florida Advanced Cardiothoracic Surgery, Department of Cardiothoracic Surgery, Tampa General Hospital, University of South Florida, Tampa, Florida, USA
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97
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Jiménez-Díaz J, Benezet-Peñaranda J, González Marín A. Outflow tract right ventricular pacing in patients with a persistent left superior vena cava. Rev Esp Cardiol 2011; 65:190-1. [PMID: 21783314 DOI: 10.1016/j.recesp.2011.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 04/13/2011] [Indexed: 11/30/2022]
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98
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Linhart M, Schwab JO, Bellmann B, Schrickel JW, Kreuz J, Balta O, Naehle CP, Strach K, Schneider C, Esmailzadeh B, Fimmers R, Nickenig G, Lickfett LM. Prevalence of asymptomatic upper extremity venous obstruction in 302 patients undergoing first implantation of cardioverter defibrillator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:684-9. [PMID: 21303390 DOI: 10.1111/j.1540-8159.2011.03035.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Little is known about the prevalence of upper extremity vein obstruction or anomalies in patients before first implantation of implantable cardioverter defibrillator (ICD). It remains unclear in which patients contrast venography is warranted before implantation procedure. METHODS Results of clinical data and contrast venography of 302 consecutive patients scheduled for first ICD implantation were analyzed. RESULTS Prevalence of upper vein obstruction was 6.6% (20/302 patients) in a typical patient population undergoing first ICD implantation. Age, left ventricular ejection fraction, underlying heart disease, prior open-heart surgery, or cardiopulmonary resuscitation were not predictors of obstruction. Patients with previous cardiac pacemaker implantation had a higher rate of obstruction, though this was not statistically significant (20% vs 15.7%, P = 0.54). Persistent left vena cava was found in 0.7%. CONCLUSION There is no clinical parameter sufficient enough to predict upper extremity venous obstruction. Contrast venography may be considered in patients with previous pacemaker placement but should not be a routine diagnostic tool in unselected patients prior to first ICD-implantation procedure.
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Affiliation(s)
- Markus Linhart
- Medizinische Klinik und Poliklinik II, University of Bonn, Bonn, Germany.
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Bissinger A, Bahadori-Esfahani F, Lubiński A. Cardiac defibrillator implantation via persistent left superior vena cava - sometimes this approach is facile. A case report. Arch Med Sci 2011; 7:161-3. [PMID: 22291750 PMCID: PMC3258695 DOI: 10.5114/aoms.2011.20623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 01/30/2010] [Accepted: 02/27/2010] [Indexed: 11/17/2022] Open
Abstract
We report a case of persistent left superior vena cava (PLSVC) incidentally recognized during the implantation of a cardioverter-defibrillator. PLSVC is the most common venous anomaly of the thorax and drains into the right atrium. There are a lot of publications reporting success of pacemaker or defibrillator lead implantations via PLSVC. In this article we present the technique of approaching the right ventricle and right atrium via PLSVC; sometimes this method can be as straightforward as the classical way. Therefore, if PLSVC is recognized intra-operatively, we suggest continuing left-sided implantation, and considering a right venous access only in case of failure.
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Affiliation(s)
- Andrzej Bissinger
- Department of Invasive Cardiology and Cardiodiabetology, University Hospital, Lodz, Poland
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Atypical Placement of Hemodialysis Catheters in Patients with Complete and Irreversible Obstruction of Central Venous Vessels. J Vasc Access 2011. [DOI: 10.5301/112972981101200101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This article describes the approach to atypical placement of central venous catheters (CVC) in dialysis patients with complete untreatable obstruction of central venous vessels. Methods Five patients with complete obstruction of central venous vessels underwent CT venography and digital venous angiography. After ultrasound-guided and radioscopic-assisted cannulation of the internal jugular vein, permanent CVCs were placed in atypical locations: in two patients a preliminary venous angioplasty was performed to facilitate the catheter positioning in a mediastinal enlarged collateral vein and in a persistent left superior vena cava; in three patients the CVC was placed in the azygos vein, enlarged because of the obstruction of the superior vena cava. Results In all cases, we achieved satisfactory morphological and functional immediate results. Hemodialysis (HD) was carried out long term in all patients except one who presented a non-functioning CVC after 4 months. In one case the catheter, still functioning well after 9 months, was removed due to kidney transplantation. The CVC in the left superior vena cava was replaced with a longer one after 12 months, and it is still functioning well 3 months after replacement. The patency of the other two catheters has to date been kept for 9 and 18 months. Conclusions The placement of CVC for HD in atypical sites can be considered a viable option in extreme cases; adequate imaging support is paramount in order to facilitate the procedure and to avoid complications.
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