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Hama J, Smith M, Erazo G. Persistent left-sided SVC: An incidental finding during Port-A-Cath placement. Radiol Case Rep 2024; 19:1832-1835. [PMID: 38420344 PMCID: PMC10899064 DOI: 10.1016/j.radcr.2024.01.066] [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: 09/05/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 03/02/2024] Open
Abstract
Port-A-Cath (port), a single-lumen, tunneled catheter, is routinely placed into the superior vena cava (SVC) for cancer patients undergoing chemotherapy. We present a case of a port placement in which variant anatomy was discovered during the fluoroscopy-guided procedure and confirmed by venogram of a persistent left-sided SVC (PLSVC). Upon further investigation into the patient's previous computed tomography (CT) scans, the diagnosis was further confirmed. Patients with PLSVC are typically asymptomatic; however, some are associated with increased congenital heart defects (CHD), which increase the risk for complications during invasive procedures. Diagnosing PLSVCs and knowing the clinical implications/complications can improve patient care; by not removing catheters unnecessarily and being prepared to treat/minimize complications.
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Affiliation(s)
- Jakob Hama
- Internal Medicine, New York City Health and Hospitals Queens Hospital Center, 82-68 164th St, Queens, NY 11432, USA
| | - Matthew Smith
- Interventional Radiology, New York City Health and Hospitals Queens Hospital Center, 82-68 164th St, Queens, NY 11432, USA
| | - Geovanna Erazo
- Interventional Radiology, New York City Health and Hospitals Queens Hospital Center, 82-68 164th St, Queens, NY 11432, USA
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2
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Pan SX, Zhang YL, Fang F. Case Report: Persistent left superior vena cava: an incidental finding during peripherally inserted central catheter placement. Front Surg 2024; 10:1254937. [PMID: 38234454 PMCID: PMC10792061 DOI: 10.3389/fsurg.2023.1254937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/13/2023] [Indexed: 01/19/2024] Open
Abstract
Background A peripherally inserted central catheter (PICC) is a specialized type of long-term intravenous catheter commonly employed for administering chemotherapy. The operation and management of PICC should exclusively be carried out by trained healthcare professionals equipped with the requisite knowledge of anatomy, procedural technique and patient care. Persistent left superior vena cava (PLSVC) is a vascular malformation which is typically asymptomatic in clinical presentation, almost always identified during invasive surgery or imaging examinations. Case presentation Herein, we detailed a case involving a breast cancer patient whose PLSVC was identified during the placement of PICC because of the negative P-wave in electrocardiogram (ECG). Subsequent examination, including chest x-ray imaging, postoperative enhanced CT of the chest, ECG, and consultation with an experienced imaging physician confirmed that the patient's variant type was PLSVC type I. 2160. Removal of the catheter was deemed unnecessary, as the catheter tip was appropriately positioned and no other concomitant cardiovascular malformations were detected. Conclusion The PLSVC is a vascular anomaly and is relatively uncommon within the general population. The operator should possess a thorough familiarity with the potential anatomical variations of left superior vena cava, and specialized case profile should be established for patients diagnosed with PLSVC.
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Affiliation(s)
| | | | - Fang Fang
- Department of Cancer Therapy, The Affiliated Hospital of Qingdao University, Qingdao, China
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3
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Fan Y, He D, Cheng J, Wu Z, Hao Y, Liu H. Successful Removal and Replacement of a Stuck Hemodialysis Catheter via Thoracotomy: Report of Two Cases and Literature Review. Case Rep Nephrol Dial 2024; 14:56-63. [PMID: 38571812 PMCID: PMC10990479 DOI: 10.1159/000537740] [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: 10/05/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction Stuck tunneled central venous catheters (CVCs) have been increasingly reported. In rare cases, the impossibility of extracting the CVC from the central vein after regular traction is the result of rigid adhesions to the surrounding fibrin sheath. Forced traction during catheter removal can cause serious complications, including cardiac tamponade, hemothorax, and hemorrhagic shock. Knowledge and experience on how to properly manage the stuck catheter are still limited. Case Presentation Here, we present two cases that highlight the successful removal of the stuck tunneled CVC via thoracotomy through the close collaboration of multidisciplinary specialists in the best possible way. Both patients underwent an unsuccessful attempt at thrombolytic therapy with urokinase, catheter traction under the guidance of digital subtraction angiography and intraluminal balloon dilation. And we reviewed the literature on stuck catheters in the hope of providing knowledge and effective approaches to attempted removal of stuck catheters. Conclusion There is no standardized procedure for dealing with stuck catheters. Intraluminal percutaneous transluminal angioplasty should be considered as the first-line treatment, while open surgery represents a second option only in the event of failure. Care must be taken that forced extubation can cause patients life-threatening.
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Affiliation(s)
- Yanqin Fan
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dejiao He
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jing Cheng
- Division of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, China
| | - Zhenzhong Wu
- Division of Interventional Radiography, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yiqun Hao
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Hongyan Liu
- Division of Nephrology, Renmin Hospital of Wuhan University, Wuhan, China
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4
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Gillis VELM, Korzilius JW, Wouters Y, Jenniskens SFM, Wanten GJA. Superior vena cava syndrome in chronic intestinal failure patients: When the going gets tough. Clin Nutr 2024; 43:197-202. [PMID: 38070211 DOI: 10.1016/j.clnu.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 11/01/2023] [Accepted: 11/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND & AIMS Catheter-related venous thrombosis is a severe complication of home parenteral nutrition (HPN) with potentially devastating consequences such as superior vena cava syndrome (SVCS). Early recognition and awareness of factors leading to its development are of paramount importance. However, studies are lacking in HPN patients focusing on this topic. In this study, we aimed to determine the incidence of SVCS in HPN patients and describe SVCS-related outcomes. METHODS This retrospective cohort study comprised all adult HPN patients who developed SVCS between 2000 and 2022 at our national HPN referral center. Primary outcome was the incidence of SVCS. Secondary outcomes include SVCS-related symptoms, tip location of central venous access device (CVAD) post-insertion and at time of SVCS, diagnostics and treatment. RESULTS SVCS was diagnosed in 38 of 616 patients (6%), with an annual cumulative incidence rate ranging between 0 and 4.2%. Most common presenting symptoms were facial edema (82%) and arm edema (50%). Post-insertion, 17% (6/36) of patients had a correct position of the CVAD tip and 11% (4/36) during SVCS diagnosis. Computed tomography was the most used diagnostic imaging technique (66%). Sixty-three percent of patients started, 11% switched, and 21% continued anticoagulant treatment. CONCLUSIONS The incidence of SVCS is relatively high in our vulnerable HPN population. It is key to recognize whenever such patients present with vascular obstruction-related symptoms and treat them in an early stage by a multidisciplinary team.
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Affiliation(s)
- V E L M Gillis
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands.
| | - J W Korzilius
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Y Wouters
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - S F M Jenniskens
- Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - G J A Wanten
- Department of Gastroenterology and Hepatology, Radboud University Medical Centre, Nijmegen, the Netherlands
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5
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Kazma H, Fouani M, Olleik M, Akil L, Mohammed M. Prolapsing Intrigue: A Case of Superior Vena Cava Mass Visualized by Echocardiography From the Subcostal Window Unveiling an Anterior Mediastinal Type B2 Thymoma. Cureus 2024; 16:e52352. [PMID: 38230386 PMCID: PMC10791096 DOI: 10.7759/cureus.52352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 01/18/2024] Open
Abstract
Imaging the superior vena cava (SVC) during two-dimensional (2D) transthoracic echocardiographic examination is challenging and should be performed routinely. Here, we present a case where a lower (juxta-atrial) SVC mass was seen prolapsing into the right atrium by 2D transthoracic echocardiography; in this case, the imaging of the lower (juxta-atrial) SVC was done from the subcostal window. It was not possible to image the SVC from the suprasternal, right supraclavicular, left parasternal, or apical windows. CT scan of the chest with intravenous contrast was done in this case and showed an anterior mediastinal mass invading the SVC and prolapsing into the right atrium. CT-guided biopsy proved the mass to be a type B2 thymoma.
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Affiliation(s)
- Hasan Kazma
- Cardiology, Bahman Hospital, Beirut, LBN
- Medicine, Faculty of Medical Sciences, Lebanese University, Beirut, LBN
| | - Mouin Fouani
- Hematology-Oncology, Bahman Hospital, Beirut, LBN
| | | | | | - Malek Mohammed
- Invasive Cardiac Laboratory, Bahman Hospital, Beirut, LBN
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6
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Fen Y, Yin W, Li-Ming G, Hui-Ling F, Wei X, Jian-Xin L, Xiao-Mei H. Diagnostic Value of Contrast-Enhanced Ultrasonography for Catheter-Related Right Brachiocephalic Vein and Superior Vena Cava Lesions in Patients Undergoing Hemodialysis-A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:2715-2724. [PMID: 37486260 DOI: 10.1002/jum.16306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 07/02/2023] [Accepted: 07/09/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVES To evaluate the diagnostic efficacy of contrast-enhanced ultrasonography (CEUS) for detecting catheter-related right brachiocephalic vein (RBV) and superior vena cava (SVC) obstructions in patients undergoing hemodialysis (HD). METHODS From June 1, 2021 to December 31, 2022, we enrolled 80 patients undergoing HD who had used or were using a central venous catheter as vascular access. We evaluated the diagnostic efficacy of conventional ultrasonography and CEUS for identifying RBV and SVC obstructions and compared them with that of digital subtraction angiography (DSA). In the stratified analysis, the SVC was divided into the upper and lower segments. In total, we analyzed 240 central venous segments, including the RBV. RESULTS Among the RBV and SVC visualized by DSA, conventional ultrasonography and CEUS could visualize 67.92 and 100% of the vein segments, respectively; however, the lengths and diameters of the RBV and SVC were smaller than those recorded with DSA (P < .001). The diagnostic efficacy of CEUS for detecting catheter-related central venous obstruction was better than that of conventional ultrasonography, with a higher sensitivity (83.95 vs 41.98%), specificity (89.94 vs 53.46%), accuracy (87.92 vs 49.58%), and F1 score (82.42 vs 49.64%). CEUS showed good agreement (κ = 0.732) with DSA. In the stratified analyses, CEUS also showed higher sensitivity (83.93, 83.33, and 84.62%, respectively) and better agreement with DSA (κ = 0.635, 0.655, and 0.673, respectively) than conventional ultrasonography for detecting the RBV and the upper and lower segments of the SVC. CONCLUSIONS CEUS had high sensitivity and specificity in diagnosing catheter-related RBV and SVC obstructions.
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Affiliation(s)
- Yu Fen
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wang Yin
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gan Li-Ming
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fu Hui-Ling
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Wei
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liu Jian-Xin
- Department of Ultrasound, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huang Xiao-Mei
- Department of Nephrology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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7
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Brouzet TA, García-Cano L, Ibáñez-Criado JL, García-Fernández A, Monteagudo-Viana M, Martínez-Martínez JG, Ibáñez-Criado A. A Novel Technique of Placing Desfibrillator Leads in Patients with Persistent Left Superior Vena Cava. Int Heart J 2023; 64:1162-1165. [PMID: 37967980 DOI: 10.1536/ihj.23-315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Persistent left superior vena cava is the most common thoracic venous anomaly. It is usually asymptomatic, but it can make implanting intracardiac devices difficult.We present a novel technique to facilitate desfibrillator lead implantation in patients with persistent left superior vena cava and the absence of the right superior vena cava. We used a fixed-curve Selectra 3D 65-42 cm sheath (Biotronik), orienting it toward the tricuspid valve (TV) by rotating it counter-clockwise. During follow-up, the electrodes remained stable.Our technique was safe, simple, and feasible for patients with this complex venous anatomy.
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Affiliation(s)
- Thomas André Brouzet
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - Laura García-Cano
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - José Luis Ibáñez-Criado
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - Amaya García-Fernández
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | | | - Juan Gabriel Martínez-Martínez
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
| | - Alicia Ibáñez-Criado
- Arrhythmia Unit, Cardiology Service, Alicante General University Hospital, Alicante Health and Biomedical Research Institute (ISABIAL)
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8
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Ding X, Liao Z, Tao Y, Wu X. A case misdiagnosed as hyperthyroid heart disease: Surgical repair of unroofed coronary sinus syndrome with severe tricuspid regurgitation. Clin Case Rep 2023; 11:e7990. [PMID: 37780931 PMCID: PMC10539682 DOI: 10.1002/ccr3.7990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/30/2023] [Accepted: 09/16/2023] [Indexed: 10/03/2023] Open
Abstract
Unroofed coronary sinus syndrome (URCS), also known as coronary sinus septal defect, is a rare congenital heart disease. Because of its special anatomy and the lack of typical clinical symptoms, the disease is easily missed and misdiagnosed. This case report particularly describes a middle-aged male patient with URCS misdiagnosed for more than 19 years, covered by hyperthyroid heart disease, who subsequently developed uncontrollable symptoms such as chest tightness and shortness of breath and came to our hospital. After a clear diagnosis in our hospital, the patient was successfully cured after treatment with coronary sinus repair and tricuspid valvuloplasty under extracorporeal circulation.
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Affiliation(s)
- Xuejiao Ding
- Department of Ultrasound Imaging, Xiaogan HospitalAffiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
| | - Zhimin Liao
- Department of Cardiothoracic SurgeryXiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
| | - Yichao Tao
- Department of Ultrasound Imaging, Xiaogan HospitalAffiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
| | - Xiaofeng Wu
- Department of Ultrasound Imaging, Xiaogan HospitalAffiliated to Wuhan University of Science and Technology, Xiaogan Central HospitalXiaoganChina
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9
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Adi O, Apoo FN, Fong CP, Ahmad AH, Panebianco N. Hypotensive patient with superior vena cava obstruction diagnosed using resuscitative transesophageal echocardiography. Am J Emerg Med 2023; 72:224.e1-224.e4. [PMID: 37500381 DOI: 10.1016/j.ajem.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Superior vena cava syndrome (SVCS) is a malignancy-related emergency. It is caused by obstruction of blood flow in the superior vena cava (SVC) secondary to intraluminal thrombosis, external compression, or direct invasion of tumor. CASE SUMMARY A 49-year-old male presented to the emergency department (ED) with acute hypoxemic respiratory failure. He was intubated and treated as pneumonia. Post-intubation, he became hypotensive, requiring fluid resuscitation and inotropic support. Resuscitative transesophageal echocardiography (TEE) showed external compression by a lung mass and an intraluminal thrombus causing SVC obstruction. Computed tomography (CT) angiography was performed, and it confirmed the TEE findings. A provisional diagnosis of lung carcinoma was made, and he underwent endovascular therapy for rapid symptomatic relief. DISCUSSION This case report highlights the role of resuscitative TEE in evaluating a hypotensive patient with clinical suspicion of SVCS at the emergency department. TEE performed at the bedside could help to diagnose and demonstrate the pathology causing SVCS in this case. TEE allowed high-quality image acquisition and was able to overcome the limitation of transthoracic echocardiography (TTE). TEE should be considered as an alternative ED imaging modality in the management of SVCS. LEARNING POINTS
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Affiliation(s)
- Osman Adi
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia.
| | - Farah Nuradhwa Apoo
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Chan Pei Fong
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Azma Haryaty Ahmad
- Resuscitation & Emergency Critical Care Unit, Trauma & Emergency Department, Hospital Raja Permaisuri Bainun, Ipoh, Perak, Malaysia
| | - Nova Panebianco
- Emergency Medicine, Division of Emergency Ultrasound, Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, United States of America.
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10
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Cochran RL, Ghoshhajra BB, Hedgire SS. Body and Extremity MR Venography: Technique, Clinical Applications, and Advances. Magn Reson Imaging Clin N Am 2023; 31:413-431. [PMID: 37414469 DOI: 10.1016/j.mric.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Magnetic resonance venography (MRV) represents a distinct imaging approach that may be used to evaluate a wide spectrum of venous pathology. Despite duplex ultrasound and computed tomography venography representing the dominant imaging modalities in investigating suspected venous disease, MRV is increasingly used due to its lack of ionizing radiation, unique ability to be performed without administration of intravenous contrast, and recent technical improvements resulting in improved sensitivity, image quality, and faster acquisition times. In this review, the authors discuss commonly used body and extremity MRV techniques, different clinical applications, and future directions.
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Affiliation(s)
- Rory L Cochran
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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11
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Wang X, Yang Y, Dong J, Wang X, Zheng Y, Chen J, Shen Y, Wang H. Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram. J Vasc Access 2023; 24:802-808. [PMID: 34585623 DOI: 10.1177/11297298211045576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.
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Affiliation(s)
- Xinpeng Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yong Yang
- Department of Critical Care Medicine (ICU), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jing Dong
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Xiaozheng Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yuanyuan Zheng
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jie Chen
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yanfen Shen
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hongzhi Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
- Department of Critical Care Medicine (ICU), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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12
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Shah RP, Bolaji O, Duhan S, Ariaga AC, Keisham B, Paul T, Aljaroudi W, Alraies MC. Superior Vena Cava Syndrome: An Umbrella Review. Cureus 2023; 15:e42227. [PMID: 37605686 PMCID: PMC10439982 DOI: 10.7759/cureus.42227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Superior vena cava syndrome (SVCS) is a medical emergency that encompasses an array of signs and symptoms due to obstruction of blood flow through the superior vena cava (SVC). It poses a significant healthcare burden due to its associated morbidity and mortality. Its impact on the healthcare system continues to grow due to the increasing incidence of the condition. This incidence trend has been attributed to the growing use of catheters, pacemakers, and defibrillators, although it is a rare complication of these devices. The most common cause of SVCS remains malignancies accounting for up to 60% of the cases. Understanding the pathophysiology of SVCS requires understanding the anatomy, the SVC drains blood from the right and left brachiocephalic veins, which drain the head and the upper extremities accounting for about one-third of the venous blood to the heart. The most common presenting symptoms of SVCS are swelling of the face and hand, chest pain, respiratory symptoms (dyspnea, stridor, cough, hoarseness, and dysphagia), and neurologic manifestations (headaches, confusion, or visual/auditory disturbances). Symptoms generally worsen in a supine position. Diagnosis typically requires imaging, and SVCS can be graded based on classification schemas depending on the severity of symptoms and the location, understanding, and degree of obstruction. Over the past decades, the management modalities of SVCS have evolved to meet the increasing burden of the condition. Here, we present an umbrella review providing an overall assessment of the available information on SVCS, including the various management options, their indications, and a comparison of the advantages and disadvantages of these modalities.
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Affiliation(s)
- Rajendra P Shah
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Olayiwola Bolaji
- Department of Internal Medicine, University of Maryland Capital Regional Medical Center, Largo, USA
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, USA
| | - Anderson C Ariaga
- Department of Internal Medicine, Vassar Brothers Medical Center, Poughkeepsie, USA
| | - Bijeta Keisham
- Sinai Center for Thrombosis and Research, Sinai Hospital of Baltimore, Baltimore, USA
| | - Timir Paul
- Section of Interventional Cardiology, University of Tennessee at Nashville/Ascension Saint Thomas Hospital, Nashville, USA
| | - Wael Aljaroudi
- Department of Cardiology, Augusta University Medical College of Georgia, Augusta, USA
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center, Detroit, USA
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13
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Overgaard DL, Tolbod LP, Gormsen LC, Madsen MA. A Persistent Left-Sided Superior Vena Cava Detected on a O-15-H 2 O PET/CT of the Heart. Clin Nucl Med 2023; 48:e221-e222. [PMID: 36716459 DOI: 10.1097/rlu.0000000000004555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT A persistent left-sided superior vena cava (PLSVC) is an uncommon finding with a prevalence of up to 0.5% in the general population. The PLSVC appears when the left anterior cardinal vein fails to regress as the ligament of Marshall during embryologic development. It is usually asymptomatic and discovered incidentally; however, its recognition is important because it might complicate invasive cardiovascular procedures. In this case, we report an incidental finding of a PLSVC detected on the O-15-H 2 O PET/CT of a patient who was referred for myocardial perfusion imaging.
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Affiliation(s)
- David Lyse Overgaard
- From the Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital
| | | | | | - Michael Alle Madsen
- From the Department of Nuclear Medicine and PET-Centre, Aarhus University Hospital
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14
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Idries IY, Sur A, Yadav R, Yadav V, Jaswani V, Zaman M. A Rare Presentation of Duplicate Superior Vena Cava Precipitating Premature Atrial Contractions: A Case Report and a Review of the Literature. Cureus 2023; 15:e37791. [PMID: 37213939 PMCID: PMC10195116 DOI: 10.7759/cureus.37791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Millions of central lines are placed each year worldwide for life-saving measures. We present a case of left internal jugular (IJ) triple lumen catheter (TLC) placement for life-saving vasopressors, which appeared to be in the left mediastinum after a confirmed chest X-ray. After correlation with a previous MRI of the heart with and without contrast, duplication of the superior vena cava (SVC), also known as persistent left SVC (PLSVC), was discovered. PLSVC often causes no symptoms to affected individuals and is usually first found as an incidental finding discovered during thoracic surgeries, cardiovascular interventional procedures, and central line insertions. Placement of TLC or central venous catheter (CVC) can be challenging in such patients and may lead to life-threatening complications such as severe arrhythmias, cardiogenic shock, pneumothorax, and tamponade. Knowing such anomalies can prevent unnecessary catheter removal and help determine the origin of some arrhythmias and dilated heart chambers in these patients.
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Affiliation(s)
- Iyad Y Idries
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | - Avtar Sur
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | - Ruchi Yadav
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
| | - Vivek Yadav
- Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York City, USA
| | - Vijay Jaswani
- Interventional Radiology, Brookdale University Hospital Medical Center, New York City, USA
| | - Mohammed Zaman
- Critical Care Medicine, Brookdale University Hospital Medical Center, New York City, USA
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15
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Ultrasound Imaging of the Superior Vena Cava: A State-of-the-Art Review. J Am Soc Echocardiogr 2023; 36:447-463. [PMID: 36754099 DOI: 10.1016/j.echo.2023.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Greater interest in imaging the superior vena cava (SVC) in recent years has arisen because of increased focus on disorders of the right heart; the growing use of transvenous access lines, dialysis catheters, and device leads; and the emergence of right ventricular mechanical circulatory support systems via the transcatheter approach. As a low-pressure venous conduit in the right upper mediastinum, the SVC is prone to compression by various pathologic processes, to invasion by malignancies originating in nearby structures, and to complications arising from intraluminal device leads and indwelling catheters. Computed tomography and magnetic resonance venography are the modalities of choice for structural imaging of the SVC. Ultrasound allows a reasonable, yet less detailed anatomic assessment of this venous conduit. Spectral and color Doppler imaging by ultrasound are the most valuable noninvasive tools for the interrogation of SVC blood flow, a marker of the filling pattern of the right heart. Analysis of the velocity, duration, and direction of the Doppler waveforms and their phasic response to respiration makes it possible to distinguish normal from abnormal flow patterns and offers diagnostic insights into disorders that affect right heart function. The aims of this review are to demonstrate the added value SVC imaging provides during transthoracic and transesophageal echocardiographic studies, to outline its usefulness for the detection and evaluation of structural abnormalities, and to detail the role of spectral Doppler imaging in aiding the diagnosis of various disorders that affect the right heart.
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16
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Computed tomography and magnetic resonance imaging of congenital thoracic systemic venous anomalies. Pediatr Radiol 2023; 53:1005-1018. [PMID: 36600100 PMCID: PMC10156895 DOI: 10.1007/s00247-022-05570-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 10/03/2022] [Accepted: 12/12/2022] [Indexed: 01/06/2023]
Abstract
We present the imaging findings of thoracic systemic venous anomalies diagnosed by computed tomography and magnetic resonance imaging. Persistent left superior vena cava is the commonest anomaly of the thoracic systemic veins encountered either incidentally as an isolated finding or associated with congenital heart disease. Inferior vena cava (IVC) interruption with azygos continuation is the second most common anomaly, which may also be isolated or be associated with left isomerism syndrome. The article will also discuss other rarer systemic venous anomalies including retroaortic brachiocephalic vein and IVC drainage into the left atrium. Finally, the impact of pre-procedure reporting of thoracic systemic venous anomalies on the choice of intervention and patient outcome will be addressed.
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17
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Orozco VM, Ricardo U, Carlos H, Paula M, Katherine F. Thoracic Vascular Variants and Anomalies: Imaging Findings, Review of the Embryology, and Clinical Features. Indian J Radiol Imaging 2022; 32:568-575. [PMCID: PMC9705143 DOI: 10.1055/s-0042-1757742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Thoracic vascular malformations are a set of complex congenital abnormalities that result in major alterations of the patient's anatomy. It can be discovered incidentally or the anomalies may generate heart failure with a right-to-left shunt, dysphagia, dyspnea, stridor, cough, recurrent bronchopulmonary infections, hypoxemia, paradoxical emboli, and occasionally apneas and massive hemothorax. The knowledge of the embryology, and the normal development of the vascular structures of the thorax, allows to understand these abnormalities—and thus helps in making an accurate diagnosis—with its possible complications, symptoms, and treatments for the patient. The following is a review of the most common thoracic vascular malformations and their imaging findings.
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Affiliation(s)
- Valentina Munera Orozco
- Radiology Universidad Pontificia Bolivariana, Colombia,Address for correspondence Valentina Múnera Orozco Radiology Universidad Pontificia BolivarianaCalle 31 # 42 a 61Colombia
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18
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Gould Rothberg BE, Quest TE, Yeung SCJ, Pelosof LC, Gerber DE, Seltzer JA, Bischof JJ, Thomas CR, Akhter N, Mamtani M, Stutman RE, Baugh CW, Anantharaman V, Pettit NR, Klotz AD, Gibbs MA, Kyriacou DN. Oncologic emergencies and urgencies: A comprehensive review. CA Cancer J Clin 2022; 72:570-593. [PMID: 35653456 DOI: 10.3322/caac.21727] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 12/12/2022] Open
Abstract
Patients with advanced cancer generate 4 million visits annually to emergency departments (EDs) and other dedicated, high-acuity oncology urgent care centers. Because of both the increasing complexity of systemic treatments overall and the higher rates of active therapy in the geriatric population, many patients experiencing acute decompensations are frail and acutely ill. This article comprehensively reviews the spectrum of oncologic emergencies and urgencies typically encountered in acute care settings. Presentation, underlying etiology, and up-to-date clinical pathways are discussed. Criteria for either a safe discharge to home or a transition of care to the inpatient oncology hospitalist team are emphasized. This review extends beyond familiar conditions such as febrile neutropenia, hypercalcemia, tumor lysis syndrome, malignant spinal cord compression, mechanical bowel obstruction, and breakthrough pain crises to include a broader spectrum of topics encompassing the syndrome of inappropriate antidiuretic hormone secretion, venous thromboembolism and malignant effusions, as well as chemotherapy-induced mucositis, cardiomyopathy, nausea, vomiting, and diarrhea. Emergent and urgent complications associated with targeted therapeutics, including small molecules, naked and drug-conjugated monoclonal antibodies, as well as immune checkpoint inhibitors and chimeric antigen receptor T-cells, are summarized. Finally, strategies for facilitating same-day direct admission to hospice from the ED are discussed. This article not only can serve as a point-of-care reference for the ED physician but also can assist outpatient oncologists as well as inpatient hospitalists in coordinating care around the ED visit.
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Affiliation(s)
- Bonnie E Gould Rothberg
- Yale Cancer Center Innovations Laboratory, Yale Comprehensive Cancer Center, New Haven, Connecticut
| | - Tammie E Quest
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Sai-Ching J Yeung
- Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Lorraine C Pelosof
- Office of Oncologic Diseases, US Food and Drug Administration, Silver Spring, Maryland
| | - David E Gerber
- Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical School, Dallas, Texas
| | - Justin A Seltzer
- Department of Emergency Medicine, University of California San Diego, San Diego, California
| | - Jason J Bischof
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Charles R Thomas
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Nausheen Akhter
- Department of Medicine, Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mira Mamtani
- Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Robin E Stutman
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Venkataraman Anantharaman
- Department of Emergency Medicine, Singapore General Hospital, SingHealth Duke-National University of Singapore Academic Medical Center, Singapore, Singapore
| | - Nicholas R Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Adam D Klotz
- Department of Medicine, Division of Urgent Care Services, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael A Gibbs
- Department of Emergency Medicine, Atrium Health-Carolinas Medical Center, Charlotte, North Carolina
| | - Demetrios N Kyriacou
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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19
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Cherry Kemmerling E. In Vitro Pressure Measurements Across an Interatrial Shunt for HFpEF Treatment. Cardiovasc Eng Technol 2022; 13:662-672. [PMID: 35106722 DOI: 10.1007/s13239-021-00607-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/15/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE Preserved ejection fraction heart failure (HFpEF) can be treated by installing a shunt in the interatrial septum, which relieves excess pressure in the left atrium by allowing blood to flow from left to right. This technique has proven effective in clinical trials, but the details of the flow through the shunted heart are not well understood. The current study aims to collect quantitative data on the relationship between pressure and flow rate in such shunts. METHODS An in vitro, shunted double atrium flow phantom was fabricated and used to investigate the relationship between pressure drop and flow across an interatrial shunt. Flow rate was controlled and the resulting pressure drop across the shunt was measured for a variety of flow cases, including steady and pulsatile flow, flow rate waveforms typical of healthy and failing hearts, and low and high heart rates. RESULTS The results show a positive relationship between shunt flow rate and pressure drop which is more pronounced in steady flow than in pulsatile flow. Increasing heart rate increases the time-averaged pressure drop across the shunt but not the maximum pressure drop. For steady-flow cases, large changes in pressure drop resulting from moderate changes in flow rate suggest a flow regime transition during parts of the cardiac cycle. Comparison of time-averaged pulsatile flow pressure measurements with steady-flow measurements and two analytical plate-orifice models suggests that none approximate pulsatile flow accurately. CONCLUSIONS The flow rate/pressure drop relationship across an in vitro model of an interatrial shunt has been measured for a variety of physiologically relevant cases. Among other things, the results suggest that steady flow approximations to the heart's pulsatile flow should be used with caution and simplified theoretical models do not approximate the flow rate/pressure drop relationship accurately.
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20
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Lu H, Wang H, Huo X, Li G. Case report of double superior vena cava and double odd vein with hypoplastic left brachiocephalic vein. J Int Med Res 2022; 50:3000605221119655. [PMID: 36071611 PMCID: PMC9459466 DOI: 10.1177/03000605221119655] [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] [Indexed: 11/17/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a common venous variation that is usually
accompanied by an absence of the left brachiocephalic vein, and displays a higher
incidence in patients with congenital heart disease. Here, the case of a 57-year-old male
patient who was found to have PLSVC on chest computed tomography (CT) during screening for
gastric cancer metastasis at the Affiliated Hospital of Qinghai University, is described.
Further coronal CT and three-dimensional reconstruction of the chest revealed the
patient's double superior vena cava (DSVC), double odd veins, and left brachiocephalic
vein dysplasia. The patient did not have congenital heart disease and the case was
associated with dysplasia of the left brachiocephalic vein, indicating an unusual and rare
venous abnormality. At the time of writing, the patient was receiving antitumour
therapy.
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Affiliation(s)
- Haowei Lu
- Graduate School of Qinghai University, Xining, Qinghai, China
| | - Heren Wang
- Graduate School of Qinghai University, Xining, Qinghai, China.,Imaging Department, Dezhou People's hospital, Dezhou, Shandong, China
| | - Xingfa Huo
- Graduate School of Qinghai University, Xining, Qinghai, China
| | - Guoyuan Li
- Department of Oncology, Affiliated Hospital of Qinghai University, Xining, Qinghai, China
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21
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Jeong ER, Kang EJ, Jeun JH. Pictorial Essay: Understanding of Persistent Left Superior Vena Cava and Its Differential Diagnosis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:846-860. [PMID: 36238921 PMCID: PMC9514584 DOI: 10.3348/jksr.2021.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 06/16/2023]
Abstract
Persistent left superior vena cava (PLSVC) is a rare congenital, thoracic, and vascular anomaly. Although PLSVCs generally do not have a hemodynamic effect, several types of PLSVC and some cardiac anomalies may manifest with clinical symptoms. The presence of PLSVC can render catheterization via left subclavian access difficult when placing a pacemaker or central venous catheter. As such, recognizing a PLSVC that is typically incidentally discovered can prevent complications such as vascular injury. Differentiating vessels found in a similar location as PLSVC is necessary when performing thoracic vascular procedures. This pictorial essay explains the multi-detector CT findings of a PLSVC, and provides a summary of other blood vessels that require differentiation during thoracic vascular procedures.
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22
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Bhutani J, Batra A, Doomra M, Mahajan K. Hemiazygous continuation of inferior vena cava draining into the coronary sinus via persistent left superior vena cava: a rare anomaly. Monaldi Arch Chest Dis 2022; 93. [PMID: 35766482 DOI: 10.4081/monaldi.2022.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/18/2022] [Indexed: 11/23/2022] Open
Abstract
We present a case of left sided inferior vena cava with hemiazygous continuation draining into the coronary sinus via the left persistent superior vena cava. This was incidentally found in an individual referred to our centre for evaluation of palpitations. These caval anomalies are rare, and are often associated with no clinical manifestations. However, it is necessary to recognize them during routine workup to avoid diagnostic and procedural pitfalls.
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Affiliation(s)
- Jaikrit Bhutani
- Department of Cardiology, Holy Heart Hospital, Rohtak, Haryana.
| | - Aditya Batra
- Department of Cardiology, Holy Heart Hospital, Rohtak, Haryana.
| | - Mridul Doomra
- Department of Cardiology, Holy Heart Hospital, Rohtak, Haryana.
| | - Kunal Mahajan
- Department of Cardiology, Holy Heart Hospital, Rohtak, Haryana.
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23
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Russell J, Koroma T, Conteh V, Coker J, Conteh S, Bharat K, Mahdi O. Persistent left superior vena cava in a 29-year-old lady with Ebstein's anomaly and complete heart block. A case report and literature review. Ann Med Surg (Lond) 2022; 78:103884. [PMID: 35734721 PMCID: PMC9207079 DOI: 10.1016/j.amsu.2022.103884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- J.B.W. Russell
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
- Corresponding author. Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone.
| | - T.R. Koroma
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - V. Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - J. Coker
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - S. Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Kumar Bharat
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - O.Z. Mahdi
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
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François CJ, Hecht EM, Roditi G, Finn JP. MR Angiography Series: Noncardiac Chest MR Angiography. Radiographics 2022; 42:E48-E49. [PMID: 35179985 DOI: 10.1148/rg.210212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This review guides readers through the selection and setup of standardized noncardiac chest MRA protocols, including contrast-enhanced MRA (CE-MRA) and noncontrast MRA (NC-MRA), sequences that can be used in a variety of clinical situations. After reviewing basic principles described in the first three tutorials in this series on CE-MRA and NC-MRA, this online presentation details the use of MRA in specific clinical scenarios: thoracic aortic aneurysm, aortic dissection, congenital heart disease, vasculitis, central veins, and pulmonary embolus. Tips and tricks for optimization of the sequences, image acquisition, and image interpretation are provided. This module is the fourth in a series created on behalf of the Society for Magnetic Resonance Angiography (SMRA), a group of researchers and clinicians who are passionate about the benefits of MRA but understand its challenges. The full digital presentation is available online. ©RSNA, 2022.
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Affiliation(s)
- Christopher J François
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.J.F.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, NHS Greater Glasgow & Clyde, Glasgow, UK (G.R.); and Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, Calif (J.P.F)
| | - Elizabeth M Hecht
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.J.F.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, NHS Greater Glasgow & Clyde, Glasgow, UK (G.R.); and Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, Calif (J.P.F)
| | - Giles Roditi
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.J.F.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, NHS Greater Glasgow & Clyde, Glasgow, UK (G.R.); and Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, Calif (J.P.F)
| | - J Paul Finn
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (C.J.F.); Department of Radiology, Weill Cornell Medicine, New York, NY (E.M.H.); Department of Radiology, NHS Greater Glasgow & Clyde, Glasgow, UK (G.R.); and Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, Calif (J.P.F)
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Vignesh S, Bhat TA. Unique Medley of Cardinal Veins: Duplicated Superior and Inferior Venae Cavae With Left Renal Agenesis and Hemiazygos Continuation of Left Inferior Vena Cava With Drainage Into Left Atrium. Vasc Endovascular Surg 2022; 56:330-334. [PMID: 35125023 DOI: 10.1177/15385744211051493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital anomalies of the superior and inferior vena cava result from abnormal embryogenesis of cardinal veins. Duplication of superior vena cava (SVC) occurs in 0.3% of the general population of which only 8% drain into the left atrium. The prevalence of double inferior vena cava (IVC) is around 0.2-3%. The reported incidence of unilateral renal agenesis ranges from 1:1100 to 1:5000, and the association of double IVC with renal agenesis has been reported in only 11 cases in the literature. The conglomeration of such rare anomalies incidentally noted in a single patient is reported in this study. A 32-year-old man was referred to our department for Computed Tomography (CT) scan of the thorax. The patient was found to have dorsal kyphoscoliosis with hemivertebrae. The SVC was duplicated with the right SVC draining into the right atrium and the left SVC draining into the left atrium. The left kidney was not visualized in the abdomen. There was dual IVC with no intercommunicating interiliac vein. The right IVC maintained its normal course, while the left IVC continued as hemiazygos vein and joined left SVC in the thorax. Also noted was the aberrant origin of the right subclavian artery. This is the first reported case of combined superior and inferior vena caval anomalies along with left renal agenesis in a single patient in the literature. A review on the embryological basis is also described in this article.
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Affiliation(s)
- Selvamurugan Vignesh
- Department of Imaging Sciences and Interventional Radiology, 29961Meenakshi Mission Hospital and Research Centre, Madurai, India
| | - Tameem Ahmad Bhat
- Department of Radiology, 30025Christian Medical College and Hospital, Vellore, India
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26
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Zhang L, Ling G, Gang Y, Yang Z, Lu Z, Gan X, Liang H, Zeng Y, Zhang X. Classification and quantification of double superior vena cava evaluated by computed tomography imaging. Quant Imaging Med Surg 2022; 12:1405-1414. [PMID: 35111634 DOI: 10.21037/qims-20-1387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND A double superior vena cava (DSVC) may cause technical difficulties in some cardiovascular procedures. However, no quantitative data exist to describe the morphological features of this anomaly. METHODS From January 2015 to January 2019, the data of 128 consecutive patients diagnosed with DSVC on computed tomography (CT) images were retrospectively analyzed. We proposed an easy and rational method for DSVC classification based on the presence or absence of the left brachiocephalic vein (LBCV), the presence or absence of an anastomotic vein bridging the bilateral superior vena cava (SVC), and the drainage pattern of the left superior vena cava (LSVC). The following classifications were established: type I, LBVC absent, LSVC drainage into the right atrium via the coronary sinus; type II, LBCV present, LSVC drainage into the right atrium via the coronary sinus; type III, LBCV absent, LSVC drainage into the right atrium via the anastomosis; type IV, LBCV present, LSVC drainage into the right atrium via the anastomosis. The length, diameter, and area of the bilateral SVC and the coronary sinus were carefully measured across the 4 types. RESULTS Type I was the most frequently occurring type (66 of 128, 51.6%), followed by type II (43 of 128, 33.6%), then type III (15 of 128, 11.7%), and type IV (4 of 128, 3.1%). The LSVC was significantly longer than the right SVC (RSVC) in all 4 types, and the diameters of the LSVC were significantly larger in types without the LBCV (i.e., types I and III) (P<0.0001 for all). Additionally, the diameter of the coronary sinus in types I and II was triple that in types III and IV (P<0.0001), which was thought to be due to increased venous blood reflux through the coronary sinus. CONCLUSIONS The anatomical features of DSVC can be satisfactorily depicted on CT. The quantitative measurement of this anomaly by the reporting radiologists could assist clinicians to minimize the procedure-associated risks.
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Affiliation(s)
- Lin Zhang
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Gonghao Ling
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Yadong Gang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhaoxia Yang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Zhibing Lu
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xuedong Gan
- Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hongqin Liang
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Yingting Zeng
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xiaochun Zhang
- Department of Radiology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Patriarcheas V, Grammoustianou M, Ptohis N, Thanou I, Kostis M, Gkiozos I, Charpidou A, Trontzas I, Syrigos N, Kotteas E, Dimakakos E. Malignant Superior Vena Cava Syndrome: State of the Art. Cureus 2022; 14:e20924. [PMID: 35004083 PMCID: PMC8727327 DOI: 10.7759/cureus.20924] [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] [Accepted: 01/04/2022] [Indexed: 11/05/2022] Open
Abstract
Superior vena cava syndrome (SVCS) is a clinical entity characterized by signs and symptoms arising from the obstruction or occlusion of the thin-walled superior vena cava (SVC) and can result in significant morbidity and mortality. Despite the rise of benign cases of SVCS, as a thrombotic complication of intravascular devices, it is most commonly seen secondary to malignancy as a consequence of thrombosis, direct invasion of tumor cells inside the vessel, or external compression. SVCS can be the initial presentation of a previously undiagnosed tumor in up to 60% of cases. Lung cancer and non-Hodgkin lymphoma (NHL) are responsible for up to 85%-90% of malignancy-related SVCS, while metastatic cancers account for approximately 10%. Herein, we review the pathophysiology, etiology, clinical presentation, diagnosis, and management of malignancy-related SVCS.
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Tumor mass in the lung with superior vena cava syndrome. ARCHIVE OF ONCOLOGY 2022. [DOI: 10.2298/aoo200521002p] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Group of symptoms due to vena cava superior obstruction is named superior vena cava syndrome. A 65-year-old female, long-standing smoker was presented with a two-week history of dry cough and facial swelling. The patient noticed a palpable mass on the right side of the neck. Computer tomography scan with contrast showed extensive, irregular, non-homogenous consolidation in the right upper lobe, involving the right hilus, surrounding the aortic arch, supra aortic branches and pleural effusion at the right side of the body. Also, ultrasound examination of supra clavicular space showed enlarged pathologic hypoehogenic lymph node without an echogenic hilum. Ultrasound guided fine needle biopsy of lymph node was performed, and cytopathology findings showed metastatic lesion from primary microcellular lung cancer, IIIC stadium, cT4N3M0. Venous angioplasty was performed showing stenosis in the superior vena cava. After balloon dilatation, the stent was placed at the site of stenosis. The patient received chemio- and radiotherapy and survival time was seven months. Superior vena cava syndrome is an urgent clinical condition, and lung cancer is the leading cause of this syndrome. Computer tomography imaging findings and endovascular stent placement are important for detection and management of the superior vena cava thrombosis.
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Ponti A, Saltiel S, Rotzinger DC, Qanadli SD. Insights Into Endovascular Management of Superior Vena Cava Obstructions. Front Cardiovasc Med 2021; 8:765798. [PMID: 34901225 PMCID: PMC8652054 DOI: 10.3389/fcvm.2021.765798] [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: 08/27/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Superior vena cava obstruction results from any limitation of blood flow through the superior vena cava. Circulation to the heart may persist through various collateral vessels whose development depends on the level of obstruction. Depending on the level and degree of occlusive disease, the severity of clinical symptoms may vary considerably, up to lethal. Etiologies have changed dramatically in recent years, mainly due to the increasing use of intravascular devices. However, guidelines for treatment are lacking, and various options are available. Endovascular therapies developed considerably in recent years, may offer a rapid improvement in symptoms and proved to be safe. However, knowledge and selection of appropriate techniques are essential to venous angioplasty, involving specific tools to guarantee satisfying outcomes. This review aims to discuss the particular venous anatomy of the upper body, the physiopathology of superior vena cava obstruction, and specificities of endovascular treatment compared with other management options.
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Affiliation(s)
- Alexandre Ponti
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Sarah Saltiel
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - David C Rotzinger
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Diagnostic Radiology and Interventional Radiology, Lausanne University Hospital (CHUV) and Univerity of Lausanne (UNIL), Lausanne, Switzerland
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Gamal El-Deen MA, Ibrahim AS, Abdeldayem EH, Elia RZ, Romeih S. Assessment of superior cavo-pulmonary anastomoses (Glenn shunt) by cardiac magnetic resonance imaging in comparison with multi-slice computed tomography. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00676-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multi-slice computed tomography (MSCT) angiography is the gold standard imaging modality to evaluate the patency of Glenn shunt and the presence of veno–veno collaterals. The goal of this study is to evaluate the ability of two cardiac magnetic resonance imaging (MRI) techniques to assess the patency of Glenn shunt and the presence of veno–veno collaterals compared to MSCT angiography.
Results
Patients with Glenn shunt had MSCT angiography and cardiac MRI using two techniques: TWIST (Time-resolved angiography With Stochastic Trajectories) and the three-dimensional (3D) post-contrast whole heart techniques. MSCT angiography and cardiac MRI images were post-processed for quantitative and qualitative assessment of Glenn shunt and veno–veno collaterals. Our study included 29 patients (17 male, 59%) with Glenn shunt, the median age was 22 years (range 3–36 years). 3D post-contrast whole heart images give similar results compared to MSCT angiography results in the evaluation of Glenn shunt and veno–veno collaterals, 100% agreement in Glenn shunt visualization and agreement was 86.2% in the detection of veno–veno collaterals with a perfect agreement (kappa = 1) as regards their proximal connection to superior vena cava (SVC). While TWIST showed lower agreement compared to MSCT angiography results, 87.5% agreement in Glenn shunt visualization and agreement was 68.9% in the detection of veno–veno collaterals with poor agreement (kappa = 0.266) as regards their proximal connection to SVC.
Conclusions
3D post-contrast whole heart MRI images have similar results as MSCT angiography in the evaluation of superior cavo-pulmonary anastomosis and can be a good and safer alternative to MSCT angiography.
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Narikawa M, Kiyokuni M, Taguchi Y, Hosoda J, Ishigami T, Ishikawa T, Tamura K, Kimura K. Successful implantation of left ventricular lead for a cardiac resynchronization therapy defibrillator through a persistent left superior vena cava using the anchor balloon technique. J Cardiol Cases 2021; 25:308-311. [DOI: 10.1016/j.jccase.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/31/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022] Open
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Song D, Park YW. Brachio-azygos transthoracic arteriovenous grafts for hemodialysis patients with bilateral central venous obstruction: A small case series. J Vasc Access 2021; 24:11297298211058580. [PMID: 34789037 DOI: 10.1177/11297298211058580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND It is difficult to find a reliable outflow vein for vascular access in hemodialysis patients with bilateral central venous obstruction. The lower extremity veins are currently used as the most common alternative veins to make a new vascular access. However, in patients not amenable to make lower extremity access, intrathoracic vein should be considered as an outflow vein, but there are limitations in its use due to postoperative complications. METHODS We introduce a series of cases that underwent arteriovenous graft operation using an intrathoracic vein, the azygos arch, as an outflow vein. Brachio-azygos transthoracic arteriovenous graft is a surgical procedure that anastomoses the azygos arch and the brachial artery with 7 mm ringed polytetrafluoroethylene graft via lateral thoracotomy without median sternotomy. RESULTS The chest tubes of the patients were removed on the third postoperative day and they discharged within a week. About 1 month later, hemodialysis was initiated through the BATAVG, and it has been used without access dysfunction. CONCLUSION Brachio-azygos transthoracic arteriovenous grafts were performed using the azygos arches without major complications. The azygos arch can be a good alternative outflow vein to make a new vascular access for hemodialysis patients with bilateral central venous obstruction.
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Affiliation(s)
- Dan Song
- Department of General Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Young Woo Park
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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Turan OE, Yilancioglu RY, Baskurt AA, Ozcan EE. An unusual 'bow tie' image in pacemaker implantation. Indian Pacing Electrophysiol J 2021; 22:51-53. [PMID: 34737013 PMCID: PMC8811277 DOI: 10.1016/j.ipej.2021.10.007] [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: 07/04/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022] Open
Abstract
Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.
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Affiliation(s)
- Oguzhan Ekrem Turan
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey.
| | | | - Ahmet Anil Baskurt
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey
| | - Emin Evren Ozcan
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey
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Abdul-Jawad Altisent O, Benetis R, Rumbinaite E, Mizarien V, Codina P, Gual-Capllonch F, Spitaleri G, Fernandez-Nofrerias E, Bayes-Genis A, Puri R. Caval Valve Implantation (CAVI): An Emerging Therapy for Treating Severe Tricuspid Regurgitation. J Clin Med 2021; 10:jcm10194601. [PMID: 34640619 PMCID: PMC8509289 DOI: 10.3390/jcm10194601] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 11/16/2022] Open
Abstract
Severe tricuspid regurgitation remains a challenging heart-valve disease to effectively treat with high morbidity and mortality at mid-term. Currently guideline-directed medical treatment is limited to escalating dose of diuretics, and the rationale and timing of open-heart surgery remains controversial. Emerging percutaneous therapies for severe tricuspid regurgitation continue to show promising results in early feasibility studies. However, randomized trial data is lacking. Additionally, many patients are deemed unsuitable for these emerging therapies due to anatomical or imaging constraints. Given the technical simplicity of the bicaval valve implantation (CAVI) technique compared to other transcatheter devices, CAVI is postulated as a suitable alternative for a wide variety of patients affected with severe+ tricuspid regurgitation. In this review we illustrate the current evidence and ongoing uncertainties of CAVI, focusing on the novel CAVI-specific devices.
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Affiliation(s)
- Omar Abdul-Jawad Altisent
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
- Correspondence: or ; Tel./Fax: +34-93-4978-988
| | - Rimantas Benetis
- Department of Cardiothoracic and Vascular Surgery, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania;
| | - Egle Rumbinaite
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.R.); (V.M.)
| | - Vaida Mizarien
- Department of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (E.R.); (V.M.)
| | - Pau Codina
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Francisco Gual-Capllonch
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Giosafat Spitaleri
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Eduard Fernandez-Nofrerias
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Antoni Bayes-Genis
- Department of Cardiology, Germans Trias University Hospital, 08916 Badalona, Spain; (P.C.); (F.G.-C.); (G.S.); (E.F.-N.); (A.B.-G.)
| | - Rishi Puri
- Department of Cardiology, Cleveland Clinic, Cleveland, OH 44195, USA;
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Fukamizu EMN, Seabra A, Otto DY, Sawamura MVY, Bordalo-Rodrigues M, Helito PVP. Vanishing bone metastasis: pictorial essay. Radiol Bras 2021; 54:336-340. [PMID: 34602670 PMCID: PMC8475168 DOI: 10.1590/0100-3984.2020.0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 10/16/2020] [Indexed: 11/22/2022] Open
Abstract
Vanishing bone metastasis (pseudopathological vertebral body enhancement) is a pitfall in the interpretation of contrast-enhanced computed tomography (CT) scans of patients with thoracic vein obstruction, mainly in the superior vena cava and brachiocephalic veins, typically being related to thrombosis due to malignant tumors. On the basis of the CT findings, pseudopathological vertebral body enhancement can be misdiagnosed as sclerotic bone metastasis, leading to unnecessary treatment. Although not rare, pseudopathological vertebral body enhancement is usually underdiagnosed by radiologists. The aim of this study is to review the pathophysiology of this phenomenon, illustrating the most common collateral venous pathways in thoracic vein obstruction and making the correlation with the CT findings.
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Affiliation(s)
| | - Adriano Seabra
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
| | - Deborah Yukiko Otto
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP, Brazil
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Massive fusiform superior vena cava aneurysm in a 47-year-old complicated by pulmonary embolism: A case report and review of literature. Clin Imaging 2021; 81:43-45. [PMID: 34598003 DOI: 10.1016/j.clinimag.2021.08.008] [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: 05/18/2021] [Revised: 07/29/2021] [Accepted: 08/09/2021] [Indexed: 11/22/2022]
Abstract
Superior vena cava (SVC) aneurysms are a rare occurrence. Given the rarity of SVC aneurysms and their propensity to be overlooked or misinterpreted on imaging, it is essential to be familiar with their appearance for accurate diagnosis, and to minimize thromboembolic risk, complications from rupture and mass effect. This report of a case of a massive fusiform SVC aneurysm that presented with pulmonary thrombo-embolism highlights the nuances of making an imaging diagnosis of SVC aneurysm and reviews the reported cases of fusiform SVC aneurysms that were diagnosed beyond childhood.
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Absent right superior vena cava with persistent left superior vena cava in a patient with COVID-19. J Artif Organs 2021; 25:170-173. [PMID: 34401951 PMCID: PMC8366489 DOI: 10.1007/s10047-021-01290-4] [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: 04/23/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023]
Abstract
Vascular injury associated with cannulation during extracorporeal membrane oxygenation (ECMO) induction is a rare but life-threatening complication. The presence of abnormal vascular anatomy increases the risk of vascular injury and should be recognized before cannulation. We report the case of a patient with coronavirus disease (COVID-19) who was expected to undergo ECMO. By performing computed tomography (CT), we identified the absence of right superior vena cava (RSVC) with a persistent left superior vena cava (PLSVC) that could have caused serious complications associated with ECMO cannulation. PLSVC is observed in less than 0.5% of the general population; however, the combination of PLSVC and an absent RSVC in visceroatrial situs solitus is extremely rare. Attempting cannulation for Veno-venous (VV)-ECMO from the right (or left) internal jugular vein to the right atrium may cause serious complications. Cannulation may fail or lead to complications even in patients with inferior vena cava malformations. Although these vascular abnormalities are rare, it is possible to avoid iatrogenic vascular injury by identifying their presence in advance. Since anatomical variations in the vessels from the deep chest and abdominal cavity cannot be visualized using chest radiography and ultrasonography, we recommend CT, if possible, for patients with severe respiratory failure, including those with COVID-19, who may be considered for VV-ECMO induction.
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Azizi AH, Shafi I, Shah N, Rosenfield K, Schainfeld R, Sista A, Bashir R. Superior Vena Cava Syndrome. JACC Cardiovasc Interv 2021; 13:2896-2910. [PMID: 33357528 DOI: 10.1016/j.jcin.2020.08.038] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/30/2020] [Accepted: 08/18/2020] [Indexed: 02/06/2023]
Abstract
Superior vena cava (SVC) syndrome comprises a constellation of clinical signs and symptoms caused by obstruction of blood flow through the SVC. The management of patients with life-threatening SVC syndrome is evolving from radiation therapy to endovascular therapy as the first-line treatment. There is a paucity of data and societal guidelines with regard to the management of SVC syndrome. This paper aims to update the practicing interventionalists with the contemporary and the evolving therapeutic approach to SVC syndrome. In addition, the review will focus on endovascular techniques, including catheter-directed thrombolysis, angioplasty, and stenting, and their associated complications.
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Affiliation(s)
- Abdul Hussain Azizi
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Irfan Shafi
- Department of Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, Michigan, USA
| | - Neal Shah
- Department of Internal Medicine, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Kenneth Rosenfield
- Department of Cardiovascular Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert Schainfeld
- Department of Cardiovascular Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Akhilesh Sista
- Department of Interventional Radiology, NYU Langone Health, New York, New York, USA
| | - Riyaz Bashir
- Department of Cardiovascular Diseases, Temple University Hospital, Philadelphia, Pennsylvania, USA.
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Gómez Varela C, Couto Rodríguez I. "Hot quadrate lobe spot" sign in chronic superior vena cava obstruction. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:805-806. [PMID: 34315213 DOI: 10.17235/reed.2021.8154/2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the case of a 65-year-old male patient who consulted for swelling of the face and neck after having a pacemaker implantated. Contrast-enhanced chest computerized tomography (CT) confirmed a thrombus within the superior vena cava (SVC). Thus, therapy with oral anticoagulants was initiated, which obtained a good clinical response and resolution of symptoms. A follow-up contrast-enhanced CT scan of the chest and abdomen showed a focal, well-delimited, hyperdense area in the IV hepatic segment during the arterial and portal venous phases, which was associated with persistence of the SVC repletion defect and the presence of multiple superficial venous collaterals in the right anterolateral thoraco-abdominal wall. The hepatic image corresponded to the sign of the "hot spot" or "hot quadrate lobe", a hepatic pseudolesion that should not be confused with other focal hypervascular lesions.
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Cho S, Song R, Park SC, Park HS, Abbasi MS, Lee J. Development of New Hemodialysis Catheter Using Numerical Analysis and Experiments. ASAIO J 2021; 67:817-824. [PMID: 33181539 DOI: 10.1097/mat.0000000000001315] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A hemodialysis (HD) catheter, especially one with a symmetric tip design, plays an important role in the long-term treatment of patients with renal failure. It is well known that the design of the HD catheter has a considerable effect on blood recirculation and thrombus formation around it, which may cause inefficiencies or malfunctions during HD. However, hemodynamic analyses through parametric studies of its designs have been rarely performed; moreover, only comparisons between the existing models have been reported. In this study, we numerically analyzed the design of the HD catheter's side hole and distal tip for evaluating their effects on hemodynamic factors such as recirculation rate (RR), shear stress, and blood damage index (BDI). The results indicated that a larger side hole and a nozzle-shaped distal tip can significantly reduce the RR and shear stress around the HD catheter. Furthermore, based on these hemodynamic insights, we proposed three new HD catheter designs and compared their performances with existing catheters using numerical and in vitro methods. These new designs exhibited lower RRs and BDI values, thus providing better performance than the existing models. These results can help toward commercialization of more efficient HD catheters.
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Affiliation(s)
- Seongsu Cho
- From the School of Mechanical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Ryungeun Song
- From the School of Mechanical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
| | - Sun Cheol Park
- Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hoon Suk Park
- Division of Nephrology, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Muhammad Salman Abbasi
- Department of Mechanical Engineering, University of Engineering and Technology, Lahore, Pakistan
| | - Jinkee Lee
- From the School of Mechanical Engineering, Sungkyunkwan University, Suwon, Republic of Korea
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Clinical analysis of 48 cases of malignant superior vena cava syndrome. World J Surg Oncol 2021; 19:185. [PMID: 34162380 PMCID: PMC8223363 DOI: 10.1186/s12957-021-02300-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background The aim of our study was to observe and compare the curative effect of radiotherapy, chemotherapy, and combined radiotherapy and chemotherapy, as well as comprehensive treatment on superior vena cava syndrome (SVCS) caused by malignant etiology. Methods A total of 48 patients with malignant SVCS admitted to our hospital from 2015 to 2020 were selected in this study. According to the different treatment methods, they were divided into radiotherapy group (group 1, 10 cases), chemotherapy group (group 2, 8 cases), combined radiotherapy and chemotherapy group (group 3, 22 cases), and comprehensive treatment group (group 4, 8 cases). Results There were no significant differences in efficacy and side effects among the four groups (all P > 0.05). Group 4 (median survival time of 36 months) could provide longer survival time than groups 1, 2, and 3 (median survival time of 10 months, 13.5 months, and 12 months, respectively). Conclusions For patients with severe symptoms or good prognosis, comprehensive treatment could be selected to improve the quality of life and prolong the survival period; for patients with mild symptoms, radiotherapy, chemotherapy, or combined radiotherapy and chemotherapy could also reduce the symptoms of SVCS and treat tumor lesions.
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Swartz MF, Hutchinson DJ, Stauber SD, Taillie ER, Alfieris GM, Cholette JM. Enoxaparin Reduces Catheter Associated Venous Thrombosis Following Infant Cardiac Surgery. Ann Thorac Surg 2021; 114:881-888. [PMID: 34062124 DOI: 10.1016/j.athoracsur.2021.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/19/2021] [Accepted: 05/03/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Central venous catheter (CVC) related venous thrombosis (VT) following pediatric cardiac surgery increases the morbidity and mortality. Although VT prevention using low dose anticoagulation has proven ineffective, anticoagulation using high dose enoxaparin to achieve a therapeutic anti-xa level has not been studied. We hypothesized that high dose enoxaparin would reduce VT after pediatric cardiac surgery. METHODS Enoxaparin was administered to infants < 150 days when post-operative CVC duration was anticipated to extend beyond 5 days. The primary outcome was the rate of VT, re-exploration for bleeding, and post-operative red blood cell (RBC) transfusions per 1,000 CVC days. RESULTS From 2012-2019, 157 infants were treated with enoxaparin. Infants were divided into two groups: 1) SubTherapeutic (SubTher) (N = 51) - therapeutic anti-xa level (0.5-1.0 IU/mL) was not achieved, 2) Therapeutic (Ther) (N = 106) - therapeutic anti-xa level was achieved. Baseline demographics demonstrated a lower age at operation within the Ther group. The SubTher group had a higher VT rate/1,000 CVC days (8.2) compared to the Ther group (2.6; p=0.005). Re-exploration for bleeding was similar between groups. The number of post-operative RBC transfusions/1,000 CVC days was significantly greater in the SubTher group (109.4 vs. 81.6; p=0.008). Multivariate analysis demonstrated that higher median anti-xa levels reduced the risk of VT (OR 0.02, CI: 0.001, 0.63; p = 0.02). CONCLUSIONS This data suggests that enoxaparin treatment resulting in a therapeutic anti-xa level reduces post-operative CVC associated VT without increasing bleeding complications.
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Affiliation(s)
- Michael F Swartz
- Department of Surgery, University of Rochester Medical Center, Rochester, New York.
| | - David J Hutchinson
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York; Department of Pharmacy Practice, Wegmans School of Pharmacy, St. John Fisher College, Rochester, New York
| | - Sierra D Stauber
- Department of Pharmacy, University of Rochester Medical Center, Rochester, New York
| | - Eileen R Taillie
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester New York
| | - George M Alfieris
- Department of Surgery, University of Rochester Medical Center, Rochester, New York; Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester New York
| | - Jill M Cholette
- Department of Pediatrics, University of Rochester Golisano Children's Hospital, Rochester New York
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de Oliveira DC, Owen DG, Qian S, Green NC, Espino DM, Shepherd DET. Computational fluid dynamics of the right atrium: Assessment of modelling criteria for the evaluation of dialysis catheters. PLoS One 2021; 16:e0247438. [PMID: 33630903 PMCID: PMC7906423 DOI: 10.1371/journal.pone.0247438] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 02/06/2021] [Indexed: 11/19/2022] Open
Abstract
Central venous catheters are widely used in haemodialysis therapy, having to respect design requirements for appropriate performance. These are placed within the right atrium (RA); however, there is no prior computational study assessing different catheter designs while mimicking their native environment. Here, a computational fluid dynamics model of the RA, based on realistic geometry and transient physiological boundary conditions, was developed and validated. Symmetric, split and step catheter designs were virtually placed in the RA and their performance was evaluated by: assessing their interaction with the RA haemodynamic environment through prediction of flow vorticity and wall shear stress (WSS) magnitudes (1); and quantifying recirculation and tip shear stress (2). Haemodynamic predictions from our RA model showed good agreement with the literature. Catheter placement in the RA increased average vorticity, which could indicate alterations of normal blood flow, and altered WSS magnitudes and distribution, which could indicate changes in tissue mechanical properties. All designs had recirculation and elevated shear stress values, which can induce platelet activation and subsequently thrombosis. The symmetric design, however, had the lowest associated values (best performance), while step design catheters working in reverse mode were associated with worsened performance. Different tip placements also impacted on catheter performance. Our findings suggest that using a realistically anatomical RA model to study catheter performance and interaction with the haemodynamic environment is crucial, and that care needs to be given to correct tip placement within the RA for improved recirculation percentages and diminished shear stress values.
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Affiliation(s)
- Diana C. de Oliveira
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - David G. Owen
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Shuang Qian
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Naomi C. Green
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Daniel M. Espino
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
| | - Duncan E. T. Shepherd
- Department of Mechanical Engineering, University of Birmingham, Birmingham, United Kingdom
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Rosalia L, Ozturk C, Van Story D, Horvath MA, Roche ET. Object‐Oriented Lumped‐Parameter Modeling of the Cardiovascular System for Physiological and Pathophysiological Conditions. ADVANCED THEORY AND SIMULATIONS 2021. [DOI: 10.1002/adts.202000216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Luca Rosalia
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Caglar Ozturk
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - David Van Story
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Markus A. Horvath
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
| | - Ellen T. Roche
- Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge MA 02139 USA
- Harvard‐MIT Program in Health Sciences and Technology Massachusetts Institute of Technology Cambridge MA 02139 USA
- Department of Mechanical Engineering Massachusetts Institute of Technology Cambridge MA 02139 USA
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Verma M, Pandey NN, Ojha V, Kumar S, Ramakrishnan S. Developmental anomalies of the superior vena cava and its tributaries: What the radiologist needs to know? Br J Radiol 2021; 94:20200856. [PMID: 33197326 DOI: 10.1259/bjr.20200856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Deviations from the normal process of embryogenesis can result in various developmental anomalies of the superior vena cava (SVC). While these anomalies are often asymptomatic, they assume clinical importance during interventions such as central venous catheterisations and pacemaker implantations and during cardiothoracic surgeries while instituting cardiopulmonary bypass and for creation of cavo-pulmonary connections. Role of imaging in identifying these anomalies is indispensable. Cross-sectional imaging techniques like CT venography and magnetic resonance (MR) venography allow direct visualisation and consequently increased detection of anomalies. CT venography plays an important role in detection of SVC anomalies as it is readily available, has excellent spatial resolution, short acquisition times and potential for reconstruction of images in multiple planes. This pictorial review focuses on the developmental anomalies of the SVC and its tributaries highlighting their embryological basis, imaging appearances on CT venography and potential clinical implications, where relevant.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Elbahlawan L, Galdo AM, Ribeiro RC. Pulmonary Manifestations of Hematologic and Oncologic Diseases in Children. Pediatr Clin North Am 2021; 68:61-80. [PMID: 33228943 DOI: 10.1016/j.pcl.2020.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Pulmonary complications are common in children with hematologic or oncologic diseases, and many experience long-term effects even after the primary disease has been cured. This article reviews pulmonary complications in children with cancer, after hematopoietic stem cell transplant, and caused by sickle cell disease and discusses their management.
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Affiliation(s)
- Lama Elbahlawan
- Division of Critical Care, Department of Pediatrics, St. Jude Children's Research Hospital, MS 620, 262 Danny Thomas Place, Memphis, TN 38105-3678, USA.
| | - Antonio Moreno Galdo
- Pediatric Pulmonology Section, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Raul C Ribeiro
- Leukemia/Lymphoma Division, International Outreach Program, Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN, USA
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Kang M, Bae J, Moon S, Chung TN. Chest radiography for simplified evaluation of central venous catheter tip positioning for safe and accurate haemodynamic monitoring: a retrospective observational study. BMJ Open 2021; 11:e041101. [PMID: 33397666 PMCID: PMC7783527 DOI: 10.1136/bmjopen-2020-041101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The tip-to-carina (TC) distance on a simple chest X-ray (CXR) has proven value in the determination of correct central venous catheter (CVC) positioning. However, previous studies have mostly focused on preventing the atrial insertion of the CVC tip, and not on appropriate positioning for accurate haemodynamic monitoring. We aimed to assess whether the TC distance could detect the passage of the CVC tip into the superior vena cava (SVC) and the right atrium (RA), and to accordingly suggest cut-off reference values for these two aspects. DESIGN Retrospective observational cohort study. SETTING Single urban tertiary level academic hospital. PARTICIPANTS 479 patients who underwent CXR and chest CT scan after the insertion of a CVC with a 24-hour interval during the study period. INTERVENTION The TC distance was measured on CXR, and the position of the CVC tip was assessed on the chest CT images. The TC distance was described as a negative or positive number if the CVC tip was above or below the carina, respectively. Receiver-operating characteristics curve analyses were conducted to ascertain the TC distance to detect SVC entrance and RA insertion of CVC tip. RESULTS The TC distance could significantly detect both SVC entrance and RA insertion (p<0.001 for both; area under curve 0.987 and 0.965, respectively), with a reference range of -6.69 to 15.61 mm. CONCLUSION The TC distance in CXR is a simple and precise method to confirm not only the safe placement of the CVC tip but also its optimal positioning for accurate haemodynamic monitoring.
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Affiliation(s)
- Minwoo Kang
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam-Si, Gyeonggi-do, Republic of Korea
| | - Jinkun Bae
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam-Si, Gyeonggi-do, Republic of Korea
| | - Sujin Moon
- School of Medicine, CHA University, Seongnam-Si, Gyeonggi-do, Republic of Korea
| | - Tae Nyoung Chung
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Seongnam-Si, Gyeonggi-do, Republic of Korea
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Vemuri KS, Revaiah PC, Bootla D, Chauhan R, Nevali KP, Jandial A, Singh Sachdeva MU, Singh D, Rohit MK. Early T Cell Precursor Leukemia Presenting With Superior Vena Cava Syndrome and Cardiac Tamponade. JACC CardioOncol 2020; 2:805-809. [PMID: 34396298 PMCID: PMC8352309 DOI: 10.1016/j.jaccao.2020.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/23/2020] [Accepted: 10/25/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Krishna Santosh Vemuri
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Pruthvi C. Revaiah
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Dinakar Bootla
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rajeev Chauhan
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Krishna Prasad Nevali
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya Jandial
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Man Updesh Singh Sachdeva
- Department of Hematology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Dushyant Singh
- Department of Internal Medicine, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Manoj Kumar Rohit
- Department of Cardiology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Leiner T, Bogaert J, Friedrich MG, Mohiaddin R, Muthurangu V, Myerson S, Powell AJ, Raman SV, Pennell DJ. SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:76. [PMID: 33161900 PMCID: PMC7649060 DOI: 10.1186/s12968-020-00682-4] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/18/2020] [Indexed: 12/22/2022] Open
Abstract
The Society for Cardiovascular Magnetic Resonance (SCMR) last published its comprehensive expert panel report of clinical indications for CMR in 2004. This new Consensus Panel report brings those indications up to date for 2020 and includes the very substantial increase in scanning techniques, clinical applicability and adoption of CMR worldwide. We have used a nearly identical grading system for indications as in 2004 to ensure comparability with the previous report but have added the presence of randomized controlled trials as evidence for level 1 indications. In addition to the text, tables of the consensus indication levels are included for rapid assimilation and illustrative figures of some key techniques are provided.
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Affiliation(s)
- Tim Leiner
- Department of Radiology, E.01.132, Utrecht University Medical Center, Heidelberglaan 100, 3584CX, Utrecht, The Netherlands.
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
- Department of Imaging and Pathology, Catholic University Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Matthias G Friedrich
- Departments of Medicine and Diagnostic Radiology, McGill University, 1001 Decarie Blvd., Montreal, QC, H4A 3J1, Canada
| | - Raad Mohiaddin
- Department of Radiology, Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- National Heart and Lung Institute, Imperial College, South Kensington Campus, London, SW7 2AZ, UK
| | - Vivek Muthurangu
- Centre for Cardiovascular Imaging, Science & Great Ormond Street Hospital for Children, UCL Institute of Cardiovascular, Great Ormond Street, London, WC1N 3JH, UK
| | - Saul Myerson
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford Centre for Clinical Magnetic Resonance Research (OCMR), University of Oxford, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
- Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue, Farley, 2nd Floor, Boston, MA, 02115, USA
| | - Subha V Raman
- Krannert Institute of Cardiology, Indiana University School of Medicine, 340 West 10th Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202-3082, USA
| | - Dudley J Pennell
- Royal Brompton Hospital, Sydney Street, Chelsea, London, SW3 6NP, UK
- Imperial College, South Kensington Campus, London, SW7 2AZ, UK
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50
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Matusik PS, Łoboda P, Krzanowska K, Popiela TJ, Heba G, Pawlik W. Presence of retained calcified fibrin sheath after central venous catheter removal: A systematic literature review. J Vasc Access 2020; 23:644-652. [PMID: 33143527 DOI: 10.1177/1129729820969328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Central venous catheters (CVC) are used in many clinical settings for a variety of indications. We performed a systematic literature review concerning case reports of retained calcified fibrin sheaths after dialysis CVC removal. The aim of our study was to systematize the knowledge regarding clinical management of this phenomenon, placing special emphasis on diagnostic radiological features in different imaging modalities, including chest radiography, echocardiography, computed tomography, and magnetic resonance imaging. We discuss the most common risk factors associated with this CVC complication. In our review, we found eight cases of hemodialysis patients. The most common risk factors associated with calcified fibrin sheath formation in the analyzed cases were pro-thrombotic and pro-calcification factors related to patient comorbidities, and prolonged catheter dwell time. Differentiating between a calcified fibrin sheath (present in about 6% of patients with long-term indwelling CVC as diagnosed by computed tomography) and a retained catheter tip can be challenging. The initial diagnosis based on imaging methods was incorrect in most of the analyzed cases. This suggests that some cases of retained fibrin sheaths may remain undetected or misinterpreted. This is important in patients with known pro-thrombotic and pro-calcification risk factors and prolonged catheter dwell time. Therefore, implementation of preventive strategies, familiarity with radiological findings of this phenomenon, comparison with previous imaging studies, and an overall comprehensive assessment with clinical data is imperative.
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Affiliation(s)
| | - Piotr Łoboda
- Department of Diagnostic Imaging, University Hospital, Cracow, Poland
| | - Katarzyna Krzanowska
- Department of Nephrology, Jagiellonian University Medical College, Cracow, Poland
| | - Tadeusz J Popiela
- Jagiellonian University Medical College, Faculty of Medicine, Chair of Radiology, Cracow, Poland
| | - Grzegorz Heba
- Second Department of Cardiology, Institute of Cardiology, Jagiellonian University, Cracow, Poland
| | - Wiesław Pawlik
- Department of Diagnostic Imaging, University Hospital, Cracow, Poland
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