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Shi H, Yan J, Wang Q, Hua Z, Li S, Zhang J. Surgical management of unroofed coronary sinus syndrome: A 20-year-single-center experience. J Card Surg 2020; 36:589-595. [PMID: 33355957 DOI: 10.1111/jocs.15269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unroofed coronary sinus syndrome (UCSS) is rare and often associated with the left superior vena cava (LSVC). We report our experience of the clinical features, diagnosis, associated anomalies, surgical procedures, and late outcomes of UCSS during a 20-year period. METHODS One hundred and fifty-nine patients with UCSS were treated surgically and followed up between May 1998 and May 2019. UCSS was confirmed by preoperative echocardiography or computerized tomography (CT) scan in 97 patients and by the surgeons intraoperatively in 62 cases, and 100 cases were associated with LSVC. Among these patients, eight cases underwent ligation, and the intracardiac tunnel or baffle was reconstructed in 71 cases to ensure drainage of the LSVC into the right atrium (RA), and the extracardiac procedure was to lead the LSVC into the RA in three patients. Coronary sinus opening was diverted to the RA by the atrial septal patch in three cases. Thirteen patients underwent the reroof procedures, and two patients had untreated LSVC. The associated cardiac lesions were corrected concomitantly. RESULTS There were five in-hospital deaths. Follow-up of 143 patients of early survivors was done, and no deaths were reported. No serious complications were observed, with the exception of avulsion of the internal tunnel patch in one patient. CONCLUSION UCSS is often misdiagnosed during preoperative evaluation of congenital heart diseases. Preoperative transthoracic echocardiography remains the most important method in the diagnosis of UCSS. We adopted multiple surgical approaches to manage the different types of UCSS with LSVC with good results.
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Affiliation(s)
- Hao Shi
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Jun Yan
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Qiang Wang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Zhongdong Hua
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Shoujun Li
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Jing Zhang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
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Savu C, Petreanu C, Melinte A, Posea R, Balescu I, Iliescu L, Diaconu C, Galie N, Bacalbasa N. Persistent Left Superior Vena Cava - Accidental Finding. In Vivo 2020; 34:935-941. [PMID: 32111807 DOI: 10.21873/invivo.11861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND/AIM The presence of the superior left vena cava represents a rare anomaly of the thoracic venous system. CASE REPORT An asymptomatic case of this type of anomaly, discovered as an accident during investigations for a different pathology (superior left pulmonary lobe tumor), is presented. A 56-year-old, heavy smoker was admitted in our clinic with a tumoral mass in the left superior pulmonary lobe discovered during a routine chest x-ray. Physical and clinical examination was normal. However, transthoracic echography noted a coronary sinus enlargement, which led to the suspicion of a thoracic venous anomaly. Contrast chest computed tomography pointed out a venous anomaly at the level of the left hemithorax originating from the cervical region, crossing the aortic arch and draining in the coronary sinus. During the examination, contrast substance was not detected in the right superior vena cava, either early or late during the computed tomography. During surgery the presence of a persistent left superior vena cava was observed, coming from the cervical region, crossing lateral to the aortic arch and draining in the coronary sinus. CONCLUSION The presence of an enlarged coronary sinus should warn the surgeon about the possibility of a thoracic venous anomaly. Identifying a persistent left superior vena cava is important due to its clinical implications, especially during certain procedures such as mounting central venous lines, cardiac cannulation or implantation of cardiac stimulators.
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Affiliation(s)
- Cornel Savu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophthisiology, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Cornel Petreanu
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophthisiology, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexandru Melinte
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophthisiology, Bucharest, Romania
| | - Radu Posea
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophthisiology, Bucharest, Romania
| | - Irina Balescu
- Department of Visceral Surgery, "Ponderas Academic Hospital", Bucharest, Romania
| | - Laura Iliescu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Fundeni" Clinical Institute, Bucharest, Romania
| | - Camelia Diaconu
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Internal Medicine, "Floreasca" Emergency Clinical Hospital, Bucharest, Romania
| | - Nicolae Galie
- Department of Thoracic Surgery, "Marius Nasta" National Institute of Pneumophthisiology, Bucharest, Romania.,Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, "Fundeni" Clinical Institute, Bucharest, Romania.,Department of Obstetrics and Gynecology, "I. Cantacuzino" Clinical Hospital, Bucharest, Romania
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Koda Y, Nishida H, Jeevanandam V, Ota T. Orthotopic heart transplantation with persistent left superior vena cava draining into coronary sinus: the anterior rerouting technique. Gen Thorac Cardiovasc Surg 2020; 69:673-678. [PMID: 33040256 DOI: 10.1007/s11748-020-01505-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We present a surgical technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus with orthotopic heart transplantation. METHODS Between January 2013 and July 2019, a total of 224 patients underwent orthotopic heart transplantation in our institution. Among them, three patients (3/224, 1.3%) had a persistent left superior vena cava draining into the coronary sinus. The persistent left superior vena cava and the coronary sinus was isolated and fully mobilized as an en bloc conduit at the time of explanting the heart. After the standard anastomoses using the bicaval technique, the conduit was routed anterior to the great vessels and anastomosed to the right atrial appendage. A smooth venous drainage into the right atrium from the rerouted persistent left superior vena cava was intraoperatively confirmed by transesophageal echocardiography. RESULTS The postoperative course was uneventful in all patients. There were no major postoperative complication and in-hospital mortality. The routed persistent left superior vena cava-coronary sinus conduits were confirmed to be patent without stenosis/obstruction by an enhanced computed tomography. Cardiac biopsies through the reconstructed persistent left superior vena cava were possible without any difficulty. CONCLUSION The anterior rerouting technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus in an orthotopic heart transplantation was feasible and reproducible.
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Affiliation(s)
- Yojiro Koda
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Hidefumi Nishida
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA.
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Zhang L, Chen ZX, Tian W, Yang XL, Guo SL. Atresia of Coronary Sinus Ostium with a Persistent Left Superior Vena Cava Demonstrated on Cardiac Computed Tomography Angiography. Chin Med J (Engl) 2018; 131:1882-1883. [PMID: 30058591 PMCID: PMC6071464 DOI: 10.4103/0366-6999.237407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Li Zhang
- Department of the First Clinical Medical College, Lanzhou University, Lanzhou, Gansu 730000, China
| | - Zi-Xian Chen
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Wei Tian
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
| | - Xin-Ling Yang
- Department of Magnetic Resonance Imaging, Cardiovascular Imaging and Intervention Center, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, Beijing 100037, China
| | - Shun-Lin Guo
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu 730000, China
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Steck DT, Tawil JN, Boettcher BT, Pagel PS. A Rare Cause of Exercise Intolerance and Progressive Dyspnea in an Elderly Woman. J Cardiothorac Vasc Anesth 2017; 31:391-394. [DOI: 10.1053/j.jvca.2016.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Indexed: 11/11/2022]
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Tanaka A, Lonchyna VA, Ota T. Persistent left superior vena cava and cardiac transplantation: Anterior rerouting with anastomosis to the right atrium. J Heart Lung Transplant 2015; 34:1215-6. [PMID: 26150233 DOI: 10.1016/j.healun.2015.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Akiko Tanaka
- Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago, Chicago, Illinois
| | - Vassyl A Lonchyna
- Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago, Chicago, Illinois
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac and Thoracic Surgery, The University of Chicago, Chicago, Illinois
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Lee HJ, Kim N, Lee H, Shim JK, Song JW. Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.1.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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To uncover what is unknown or forgotten - cardiac magnetic resonance in the identification of vascular pathologies in patients after tetralogy of Fallot repair. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:104-9. [PMID: 25061456 PMCID: PMC4108734 DOI: 10.5114/pwki.2014.43516] [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: 03/24/2014] [Revised: 04/02/2014] [Accepted: 04/11/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION In patients with repaired tetralogy of Fallot (TOF), various pathologies of the vascular system (both arterial and venous) may be present as a result of the previous therapeutic procedures or due to the congenital disease itself. Because of the limited diagnostic capabilities in the past, lacking surgical reports of patients operated on several decades ago and/or a long time since a corrective procedure, some of these pathologies/anomalies may remain unknown. AIM To identify selected vascular pathologies with the use of cardiac magnetic resonance in patients after TOF repair. MATERIAL AND METHODS We included 208 consecutive patients (median age 24.9 years, interquartile range 20.5-36.7; 126 (60.6%) males) with repaired TOF undergoing cardiac magnetic resonance (CMR) imaging. RESULTS Significant unexpected vascular pathologies/anomalies were found in 30 patients (14.4%) and included: uni- or bilateral occlusion of the subclavian artery (n = 20), persistent left superior vena cava (n = 7, in 1 case draining into the left atrium), occluded subclavian vein (n = 1), and interruption of the inferior vena cava (n = 2). Additionally, 1 patient with the left subclavian artery occluded had an occlusion of the brachiocephalic vein. In none of the patients was the information about the uncovered pathology/anomaly present either in the referral information or in the present medical history. CONCLUSIONS The CMR in patients with repaired TOF may uncover some pathologies/anomalies which were unknown or forgotten at the time of patients' referral for the study, and which may have a significant impact on patient management.
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