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Rivera E, Trivedi K, Cao G. Septal Defects: Unveiling Sex-Based Disparities and Screening Challenges for Timely Intervention Through a Case Report and Systematic Literature Review. Cureus 2024; 16:e65752. [PMID: 39144879 PMCID: PMC11324003 DOI: 10.7759/cureus.65752] [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: 07/30/2024] [Indexed: 08/16/2024] Open
Abstract
Atrial septal defects (ASDs), comprising a significant portion of congenital cardiac anomalies, encompass a rarer and more diagnostically challenging subset known as sinus venosus ASDs (SVASDs). ASDs are more prevalent in females, and the prognosis for patients under 40 years of age is generally favorable with advancements in surgical and transcatheter interventions. However, undiagnosed ASDs in adults above 40 years old, especially females, often lead to severe complications, including pulmonary hypertension, atrial fibrillation, Eisenmenger syndrome, and a mortality rate exceeding 50%. Our detailed case study focuses on an obese 42-year-old Hispanic migrant female with chronic respiratory failure misattributed to pulmonary hypertension, resulting in the progression of complications from undiagnosed SVASD. Further investigation using contrast-enhanced transesophageal echocardiography (TEE) elucidated the correct diagnosis four years after her initial presentation. This report explores the potential factors contributing to the patient's delayed diagnosis and development of advanced cardiac complications of pulmonary hypertension leading to Eisenmenger syndrome that precluded her from procedural intervention. Furthermore, this report pioneers the first thorough review of case reports in adults newly diagnosed with SVASD, revealing sex-based differences in complications.
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Affiliation(s)
- Elsy Rivera
- Internal Medicine, Methodist Health System, Dallas, USA
| | - Kathan Trivedi
- Internal Medicine, Methodist Dallas Medical Center, Dallas, USA
| | - George Cao
- Internal Medicine, Methodist Health System, Dallas, USA
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Matsumura K, Maeda T, Kotoku A, Onishi Y. Usefulness of Transesophageal Echocardiography in Diagnosing the Cause of Circulatory Collapse During Reoperation for an Inferior Vena Cava-Left Atrium Shunt After Atrial Septal Defect Closure: A Case Report. A A Pract 2024; 18:e01818. [PMID: 39066688 DOI: 10.1213/xaa.0000000000001818] [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: 07/30/2024]
Abstract
Iatrogenic inferior vena cava (IVC)-left atrium (LA) shunt is a rare complication in atrial septal defect (ASD) surgery, caused by mistaking the Eustachian valve for the lower margin of the ASD. In this report, we describe the case of a 45-year-old woman who experienced circulatory collapse at termination of cardiopulmonary bypass during surgical IVC-LA shunt repair. Transesophageal echocardiography helped identify stenosis between the IVC and the right atrium, caused by a residual original incorrectly placed ASD patch. Removal of most of the patch led to improvement in circulatory failure.
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Affiliation(s)
- Kaori Matsumura
- From the Department of Anesthesiology, Osaka General Medical Center, Osaka, Japan
| | | | - Akiyuki Kotoku
- Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yoshihiko Onishi
- Department of Anesthesiology, The Sakakibara Heart Institute of Okayama , Japan
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Font CM, Fernandez AB, Kadariya D. Unveiling sinus venosus atrial septal defect and partial anomalous pulmonary venous return in an elderly patient. J Geriatr Cardiol 2024; 21:462-464. [PMID: 38800542 PMCID: PMC11112156 DOI: 10.26599/1671-5411.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Affiliation(s)
- Cristina M Font
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Anamarys Blanco Fernandez
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Dinesh Kadariya
- Department of Medicine, Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
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Kazma H, Fakih M, Raad A, Saleh A, Mohammed M. Cor Triatriatum Dexter With a Sinus Venosus Atrial Septal Defect in a 50-Year-Old Woman: A Case Report. Cureus 2024; 16:e53477. [PMID: 38439997 PMCID: PMC10910018 DOI: 10.7759/cureus.53477] [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: 02/02/2024] [Indexed: 03/06/2024] Open
Abstract
The diagnosis of atrial septal defect (ASD) may be delayed until adulthood or even later in life as it is a well-tolerated congenital heart disease. If patients are not examined and investigated well in childhood, the diagnosis may be delayed until later in adulthood when patients present with palpitations and sometimes dyspnea due to the right chambers dilatation from right ventricular volume overload. In this report, we present a case of a 50-year-old female patient with symptoms of heart failure and atrial fibrillation who was found to have dilated right cardiac chambers, dilated pulmonary artery, severe tricuspid regurgitation, pulmonary hypertension, and a pulmonary-to-systemic flow ratio (Qp/Qs) of more than 1.5 by transthoracic echocardiography and Doppler, indicating left to right shunt at the atrial level. However, transthoracic echocardiography could not visualize the defect, and two-dimensional (2D) transesophageal echocardiography was done in this patient and documented the presence of a sinus venosus ASD with an incomplete cor triatriatum dexter membrane; all four pulmonary veins were identified going to the left atrium. Since the presence of an incomplete cor triatriatum dexter membrane (despite causing no symptoms) makes the percutaneous closure of the sinus venosus ASD and the percutaneous repair of tricuspid regurgitation very difficult, we decided to advise surgical ASD closure and tricuspid valve repair for the patient.
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Affiliation(s)
- Hasan Kazma
- Cardiology, Bahman Hospital, Beirut, LBN
- Medicine, Lebanese University Faculty of Medical Sciences, Beirut, LBN
| | - Malak Fakih
- Cardiology, Bahman Hospital, Beirut, LBN
- Cardiology, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Ali Raad
- Pulmonary and Critical Care, Bahman Hospital, Beirut, LBN
| | - Aalaa Saleh
- General Medicine, Lebanese University Faculty of Medical Sciences, Beirut, LBN
| | - Malek Mohammed
- Invasive Cardiac Laboratory, Bahman Hospital, Beirut, LBN
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Oe A, Honda S, Yamano M, Kawasaki T. A Case of Sinus Venosus Atrial Septal Defect: Physical Examination as a Diagnostic Clue. Cureus 2024; 16:e51479. [PMID: 38298286 PMCID: PMC10830150 DOI: 10.7759/cureus.51479] [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: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
An atrial septal defect (ASD) may be detected later in life due to its asymptomatic status. We report a case of superior sinus venosus ASD, a rare type of ASD, in which bedside physical examination was useful for the diagnosis. A 72-year-old male was referred to cardiology during the treatment of a cerebral infarction. On examination, a right ventricular heave, a split-second heart sound with an increased pulmonary component, and a systolic ejection murmur in the pulmonary region were noted. Transthoracic echocardiography showed a systolic pulmonary artery pressure of 50 mmHg with right heart enlargement, but there was no shunt flow. Because an agitated saline contrast study was positive, transesophageal echocardiography was performed and demonstrated direct flow between the left atrium and superior vena cava. Our report highlights the importance of considering ASD, such as sinus venosus type, even in the absence of transthoracic echocardiographic findings suggestive of this condition, when patients present with a bedside physical examination consistent with ASD.
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Affiliation(s)
- Ayaka Oe
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, JPN
| | - Sakiko Honda
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, JPN
| | - Michiyo Yamano
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, JPN
| | - Tatsuya Kawasaki
- Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, JPN
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Patel H, Barmore W. A rare case of sinus venosus atrial septal defect: Malpositioned right atrial pacemaker lead in the left atrium. J Cardiol Cases 2023; 27:203-206. [PMID: 37180217 PMCID: PMC10173402 DOI: 10.1016/j.jccase.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/31/2022] [Accepted: 01/13/2023] [Indexed: 02/17/2023] Open
Abstract
Incidental discovery of sinus venosus atrial septal defect (SV-ASD) in the elderly is rare. This defect allows for lead malpositioning during pacemaker placement and can lead to catastrophic cardioembolic events. Post-pacemaker implantation, chest radiography should be obtained to detect malpositioning early, and if detected, lead adjustment is recommended; if identified later, treatment with an anticoagulant is feasible. SV-ASD repair may be considered as well.
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Multimodality imaging in delineation of complex sinus venosus defects and treatment outcomes over the last decade. Cardiol Young 2022; 32:1112-1120. [PMID: 34521491 DOI: 10.1017/s1047951121003851] [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] [Indexed: 11/07/2022]
Abstract
BACKGROUND Diagnosis of sinus venosus defects, not infrequently associated with complex anomalous pulmonary venous drainage, may be delayed requiring multimodality imaging. METHODS Retrospective review of all patients from February 2008 to January 2019. RESULTS Thirty-seven children were diagnosed at a median age of 4.2 years (range 0.5-15.5 years). In 32 of 37 (86%) patients, diagnosis was achieved on transthoracic echocardiography, but five patients (14%) had complex variants (four had high insertion of anomalous vein into the superior caval vein and three had multiple anomalous veins draining to different sites, two of whom had drainage of one vein into the high superior caval vein). In these five patients, the final diagnosis was achieved by multimodality imaging and intra-operative findings. The median age at surgery was 5.2 years (range 1.6-15.8 years). Thirty-one patients underwent double patch repair, four patients a Warden repair, and two patients a single-patch repair. Of the four Warden repairs, two patients had a high insertion of right-sided anomalous pulmonary vein into the superior caval vein, one patient had bilateral superior caval veins, and one patient had right lower pulmonary vein insertion into the right atrium/superior caval vein junction. There was no post-operative mortality, reoperation, residual shunt or pulmonary venous obstruction. One patient developed superior caval vein obstruction and one patient developed atrial flutter. CONCLUSION Complementary cardiac imaging modalities improve diagnosis of complex sinus venosus defects associated with a wide variation in the pattern of anomalous pulmonary venous connection. Nonetheless, surgical treatment is associated with excellent outcomes.
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Qiu JK, Bamira D, Vainrib AF, Latson LA, Halpern DG, Chun A, Saric M. Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults. CASE 2022; 6:107-113. [PMID: 35602989 PMCID: PMC9120852 DOI: 10.1016/j.case.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
SVASD should be suspected in cases of unexplained RV volume overload. Direct visualization of SVASD with TTE is difficult in adults compared with children. TEE is helpful for diagnosing SVASD and associated pulmonary venous abnormalities. Multimodal imaging techniques offer incremental value in the workup of SVASD.
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Shimajiri H, Harada Y, Kinoshita M, Mikami S. Sinus venosus atrial septal defect and partial anomalous pulmonary venous connection in a patient with dextrocardia. BMJ Case Rep 2022; 15:15/2/e245523. [PMID: 35228216 PMCID: PMC8886361 DOI: 10.1136/bcr-2021-245523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
An 85-year-old woman presenting with symptomatic pulmonary hypertension (PH) with a history of dextrocardia was referred to our facility for treatment of heart failure. Significant shunting was detected by measuring oxygen saturation during right heart catheterisation (RHC). CT with contrast revealed sinus venosus atrial septal defect (SVASD) and partial anomalous pulmonary venous connection (PAPVC), in which the left upper and middle lobar pulmonary veins returned to the superior vena cava and right atrium. Despite medical treatment, the patient died, and an autopsy was performed. SVASD and PAPVC are rare congenital anomalies. RHC with measurement of oxygen saturation and CT with contrast should be considered in patients with unexplained right atrial and ventricular enlargement or suspected PH.
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Affiliation(s)
- Hiroto Shimajiri
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Yu Harada
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Mirai Kinoshita
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
| | - Shinsuke Mikami
- Department of Cardiology, Shobara Red Cross Hospital, Shobara, Hiroshima, Japan
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Severe pulmonary stenosis hiding sinus venosus atrial septal defect: A case report. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2021. [DOI: 10.1016/j.ijcchd.2021.100110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Samiei N, Akiash N, Djafari Naeini S, Nikpajouh A, Pazoki M. The Presence of Patent Foramen Ovale in the Superior Type of Sinus Venosus Atrial Septal Defect. J Tehran Heart Cent 2020; 15:98-104. [PMID: 33552204 PMCID: PMC7827115 DOI: 10.18502/jthc.v15i3.4218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: The superior type of sinus venosus atrial septal defect (SVASD) is a rare form of the atrial septal defect (ASD) in which the upper part of the atrial septum does not exist. The presence of other cardiac anomalies such as anomalous pulmonary venous connections has been reported in this type of congenital heart disease. This study aimed to assess the presence of the patent foramen ovale (PFO) in patients with the superior type of SVASD. Methods: This retrospective case-control study on 387 patients, consisting of 187 patients with a definite SVASD and 200 patients with problems other than the ASD, was conducted in Rajaie Cardiovascular Medical and Research Center between February 2005 and July 2014. Seven patients with inadequate data were excluded from the analysis. The presence/absence of the PFO was also evaluated in the case and control groups. Results: The analyses were performed on 182 male and 198 female patients at a mean age of 39.07±14.41 and 51.01±15.80 years in the case and control groups, respectively. The PFO was significantly more frequent in the patients with the superior type of SVASD than in those without the condition (P<0.001). The persistence of the left superior vena cava was seen in 34 out of 180 patients with SVASD and in 1 out of 200 patients without the condition (18.9% vs 0.5%; P<0.001). Conclusion: This study was the first to highlight the coexistence of the PFO and the superior type of SVASD. Physiological, genetic, or fetal factors may play an important role in the association between the PFO and the SVASD.
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Affiliation(s)
- Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nehzat Akiash
- Atherosclerosis Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Sepideh Djafari Naeini
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Akbar Nikpajouh
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Pazoki
- Rasul Akram General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Affiliation(s)
- Nicholas A Oh
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - John E Mayer
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
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Vodusek Z, Khaliqdina S, Borz-Baba C, Scandrett R. Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis. Cureus 2019; 11:e5936. [PMID: 31788393 PMCID: PMC6858266 DOI: 10.7759/cureus.5936] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Sinus venosus atrial septal defect (SVASD) is a rare adult congenital heart disease which permits shunting of blood from the systemic to the pulmonary circulation and is commonly associated with anomalous pulmonary venous return. We report a case of a 27-year-old man with a history of premature birth and unilateral cryptorchidism who was admitted for syncope. Electrocardiogram (ECG) demonstrated atrial fibrillation (AF)and S1Q3T3 pattern along with an incomplete right bundle branch block. Transthoracic echocardiography (TTE) suggested the presence of right ventricular pressure and volume overload and severe right ventricular and right atrial enlargement. The agitated saline study was negative suggesting no inter-atrial communication. Transesophageal echocardiography (TEE) demonstrated a superior SVASD and raised the possibility of an anomalous pulmonary venous connection. Chest computed tomography identified the right superior pulmonary vein connection to the superior vena cava. The diagnosis of SVASD poses multiple challenges from the variety of symptoms to the selection of appropriate imaging and the complexity of surgical treatment.
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Affiliation(s)
- Ziga Vodusek
- Internal Medicine, Frank H. Netter M.D. School of Medicine at Quinnipiac University, North Haven, USA
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Biatrial drainage of right superior caval vein with preferential streaming into the left atrium. Cardiol Young 2019; 29:996-998. [PMID: 31204631 DOI: 10.1017/s1047951119001276] [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] [Indexed: 11/06/2022]
Abstract
Biatrial drainage of the right superior caval vein is an extremely rare cardiac anomaly that generally presents in childhood. We present a case of anomalous connection of the right superior caval vein with superior sinus venosus atrial septal defect and partial anomalous pulmonary venous return in a 5-month-old male presenting with unexplained cyanosis and hypoxia.
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Abdullah HAM, Alsalkhi HA, Khalid KA. Transcatheter closure of sinus venosus atrial septal defect with anomalous pulmonary venous drainage: Innovative technique with long‐term follow‐up. Catheter Cardiovasc Interv 2019; 95:743-747. [DOI: 10.1002/ccd.28364] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/04/2019] [Accepted: 05/28/2019] [Indexed: 11/05/2022]
Affiliation(s)
| | - Hussein A. Alsalkhi
- Department of Pediatric CardiologyCollege of Medicine, Kufa University Najaf Iraq
| | - Khalid A. Khalid
- Department of Pediatric CardiologyCollege of Medicine, University of Basrah Basrah Iraq
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Puchalski MD, Lui GK, Miller-Hance WC, Brook MM, Young LT, Bhat A, Roberson DA, Mercer-Rosa L, Miller OI, Parra DA, Burch T, Carron HD, Wong PC. Guidelines for Performing a Comprehensive Transesophageal Echocardiographic. J Am Soc Echocardiogr 2019; 32:173-215. [DOI: 10.1016/j.echo.2018.08.016] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Idiopathic pulmonary arterial hypertension with coexisting CHD. Cardiol Young 2018; 28:743-746. [PMID: 29316988 DOI: 10.1017/s1047951117002876] [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] [Indexed: 11/07/2022]
Abstract
Sinus venosus atrial septal defect can result in an increase in pulmonary blood flow and vascular resistance, leading to pulmonary hypertension. Rarely, the degree of pulmonary hypertension is out of proportion to the degree of intra-cardiac shunting. This case outlines the differences between pulmonary hypertension secondary to CHD and idiopathic pulmonary hypertension, and illustrates the investigation and management strategy used in a patient with features of both.
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19
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Sengupta PP, Khandheria BK. Transesophageal Echocardiography: Principles and Application. Echocardiography 2018. [DOI: 10.1007/978-3-319-71617-6_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Sharma AK, Nath RK, Pandit N. A case of sinus venosus atrial septal defect misdiagnosed as primary pulmonary hypertension. Hellenic J Cardiol 2016; 57:124-8. [PMID: 27445029 DOI: 10.1016/j.hjc.2016.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 06/25/2015] [Indexed: 10/21/2022] Open
Abstract
We present a case of sinus venosus atrial septal defect in a patient who was previously diagnosed as having primary pulmonary hypertension in a tertiary care center. Our findings are based on 2-dimensional trans-thoracic echocardiography, chest X-ray and surface electrocardiogram. A 26-year-old man, previously diagnosed as a case of primary pulmonary hypertension, presented to the emergency department (ED) with chest pain and breathlessness on exertion. Cardiac biomarkers were within their normal ranges. Surface electrocardiogram showed right atrial and ventricular overload with right axis deviation. Chest imaging noted enlarged central pulmonary vascularity with bilateral plethoric lung fields. Trans-thoracic echocardiography showed a dilated right atria and ventricle with severe tricuspid regurgitation and severe pulmonary artery hypertension with an intact atrial septum. Surprisingly, the transoesophageal echocardiogram revealed the presence of a sinus venous superior vena cava-type atrial septal defect with the right pulmonary vein draining into the right atria. In this full-text version, we present a more detailed discussion of sinus-venous atrial septal defect associated with partial anomalous pulmonary venous return that was wrongly diagnosed as a case of primary pulmonary hypertension in a tertiary care center.
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Affiliation(s)
- Awadhesh Kr Sharma
- DM 3rd yr, Senior Resident, Department of Cardiology, PGIMER & Dr Ram Manoher Lohia Hospital, New Delhi 110001, India.
| | - Ranjit Kumar Nath
- DM, Professor, Department of Cardiology, PGIMER & Dr Ram Manoher Lohia Hospital, New Delhi 110001, India
| | - Neeraj Pandit
- DM, Professor & Head, Department of Cardiology, PGIMER & Dr Ram Manoher Lohia Hospital, New Delhi 110001, India
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Alhamshari YSM, Punjabi C, Pressman GS, Govil A. Sinus venosus atrial septal defect presenting with brain abscesses in a 77-year-old immunocompetent patient. BMJ Case Rep 2015; 2015:bcr-2015-212165. [PMID: 26475881 DOI: 10.1136/bcr-2015-212165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We present a case of 77-year-old immunocompetent patient who initially presented with vertigo, nausea and vomiting, with symptoms later progressing to headaches and increased lethargy. Brain MRI revealed ring-enhancing lesions typical of abscesses in the right cerebellum. Transoesophageal echocardiogram (TEE) was performed to look for the source of his abscesses, and uncovered a sinus venosus type atrial septal defect. Cardiac CT was carried out; the patient was found to have a sinus venosus atrial septal defect with partial anomalous pulmonary venous return. Moreover, dental examination showed multiple dental caries with poor oral hygiene. The patient was started on intravenous empiric antibiotics and steroids. Subsequent brain imaging showed almost complete resolution of the abscesses. The patient's symptoms started to improve, and he was eventually sent to an intensive rehabilitation centre with future plans to surgically correct his congenital heart disease to prevent further complications.
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Affiliation(s)
- Yaser S M Alhamshari
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Chitra Punjabi
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Gregg S Pressman
- The Institute for Heart and Vascular Health and Cardiovascular Diseases, Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | - Anita Govil
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania, USA
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Sinus venosus atrial septal defect as a cause of palpitations and dyspnea in an adult: a diagnostic imaging challenge. Case Rep Med 2015; 2015:128462. [PMID: 25705227 PMCID: PMC4326212 DOI: 10.1155/2015/128462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/05/2015] [Accepted: 01/10/2015] [Indexed: 11/17/2022] Open
Abstract
Sinus venosus atrial septal defects (SV-ASD) have nonspecific clinical presentations and represent a diagnostic imaging challenge. Transthoracic echocardiography (TTE) remains the initial diagnostic imaging modality. However, detection rates have been as low as 12%. Transesophageal echocardiography (TEE) improves diagnostic accuracy though it may not detect commonly associated partial anomalous pulmonary venous return (PAPVR). Cardiac magnetic resonance (CMR) imaging provides a noninvasive, highly sensitive and specific imaging modality of SV-ASD. We describe a case of an adult male with exercise-induced, paroxysmal supraventricular tachycardia who presented with palpitations and dyspnea. Despite nondiagnostic imaging results on TTE, CMR proved to be instrumental in visualizing a hemodynamically significant SV-ASD with PAPVR that ultimately led to surgical correction.
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Abstract
A 63-year-old man was evaluated in consultation for unexplained dyspnea. At the time of the initial clinical encounter at our institution, the patient endorsed a 10-year history of progressive exertional dyspnea, which had become debilitating over the preceding 3 months and was characterized by shortness of breath accompanying subtle physical activities such as tying shoelaces. The patient underwent multiple hospital admissions reportedly for the treatment of congestive heart failure ascribed to impaired left ventricular (LV) diastolic function. Review of systems identified postural dizziness and history of near syncope, possible nocturnal dyspnea, and peripheral neuropathy, but not cardiac angina, orthopnea, nocturia, edema, cough, palpitations, syncope, claudication, or other cardiopulmonary symptoms. He related that he was first noted to have a cardiac murmur detected 4 decades previously during a military service physical examination but that the murmur was not characterized further and that he served in the Vietnam conflict without functional limitation. The patient’s relevant medical history included rate-controlled atrial fibrillation, 90 pack-year tobacco use (3 packs daily between 21 and 51 years of age), dyslipidemia, systemic hypertension, type 2 diabetes mellitus, moderate chronic obstructive pulmonary disease, obstructive sleep apnea not currently treated, and gastrointestinal bleed caused by colon cancer treated with hemicolectomy 11 years earlier. There was no illicit drug use, but a remote history of heavy alcohol consumption was reported. Family history was unremarkable except that his father died at 55 years of age of myocardial infarction. Medications included aspirin 81 mg daily, warfarin 2 mg daily, losartan 50 mg daily, metoprolol tartrate 25 mg twice daily, simvastatin 10 mg daily, fenofibrate 48 mg daily, albuterol inhaler 90-μg puffs as needed, and gabapentin 300 mg 3 times daily.
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Affiliation(s)
- David M Dudzinski
- From the Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston (D.M.D.); Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA (D.L.B., J.R.A., B.A.M.); and Brigham and Women's Hospital and Harvard Medical School, Division of Cardiovascular Medicine, Boston, MA (D.L.B., J.R.A., B.A.M.)
| | - Deepak L Bhatt
- From the Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston (D.M.D.); Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA (D.L.B., J.R.A., B.A.M.); and Brigham and Women's Hospital and Harvard Medical School, Division of Cardiovascular Medicine, Boston, MA (D.L.B., J.R.A., B.A.M.)
| | - Jayashri R Aragam
- From the Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston (D.M.D.); Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA (D.L.B., J.R.A., B.A.M.); and Brigham and Women's Hospital and Harvard Medical School, Division of Cardiovascular Medicine, Boston, MA (D.L.B., J.R.A., B.A.M.)
| | - Bradley A Maron
- From the Massachusetts General Hospital and Harvard Medical School, Division of Cardiology, Boston (D.M.D.); Department of Cardiology, Veterans Affairs Boston Healthcare System, Boston, MA (D.L.B., J.R.A., B.A.M.); and Brigham and Women's Hospital and Harvard Medical School, Division of Cardiovascular Medicine, Boston, MA (D.L.B., J.R.A., B.A.M.).
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Wang H, Guan H, Wang DW. Partial anomalous pulmonary venous connection to superior vena cava that overrides across the intact atrial septum and has bi-atrial connection in a 75-year-old female presenting with pulmonary hypertension. BMC Cardiovasc Disord 2014; 14:149. [PMID: 25344786 PMCID: PMC4219022 DOI: 10.1186/1471-2261-14-149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 10/17/2014] [Indexed: 12/04/2022] Open
Abstract
Background Partial anomalous venous connection (PAPVC) is a rare congenital heart disease where the blood flow from one or more pulmonary veins (but not all) returns to the right atrium or systemic venous circulation and is often associated with a sinus venosus atrial defect (SVD). Transthoracic echocardiography (TTE) can provide limited information for this anomaly and the diagnosis of this congenital defect has been a clinical challenge. Case presentation We report here a case of a 75-year-old female with adult-onset pulmonary arterial hypertension (PAH), hypoxemia and right-sided chamber dilatation. The diagnosis of PAPVC was made incidentally by multidetector computed tomographic angiography (MCTA) that was performed to exclude pulmonary embolism. In this type of PAPVC, the atrial septum is intact, the right upper pulmonary vein (RUPV) connects to the superior vena cava (SVC), and the SVC overrides across the atrial septum and has bi-atrial connection, all of which are clearly manifested by MCTA. Conclusions This case indicates the need to exclude a PAPVC and SVD in unexplained pulmonary hypertension, and MCTA is a reliable non-invasive imaging technique with high resolution and wide anatomic coverage. The case also demonstrates that the coexisting SVD with PAPVC is an anomalous venous connection instead of atrial septal defect (ASD) and its key feature is the overriding of SVC or IVC across the intact atrial septum.
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Affiliation(s)
| | | | - Dao Wen Wang
- Division of Cardiology and Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, 1905 Jiefang Dadao, Wuhan 430030, PR China.
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Ganigara M, Tanous D, Celermajer D, Puranik R. The role of cardiac MRI in the diagnosis and management of sinus venosus atrial septal defect. Ann Pediatr Cardiol 2014; 7:160-2. [PMID: 24987269 PMCID: PMC4070212 DOI: 10.4103/0974-2069.132509] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Sinus venosus atrial septal defects (SV-ASDs) are inter-atrial communications caused by a deficiency of the common wall between the superior or inferior vena cava and the right-sided pulmonary veins. The diagnosis can be challenging, especially in adults with delayed presentation. We present images that illustrate an example of the role of cardiac magnetic resonance imaging (CMRI) in the diagnosis and follow-up of a patient with SV-ASD.
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Affiliation(s)
- Madhusudan Ganigara
- Department of Cardiology, Faculty of Medicine, The University of Sydney, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David Tanous
- Department of Cardiology, Faculty of Medicine, The University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia
| | - David Celermajer
- Department of Cardiology, Faculty of Medicine, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Rajesh Puranik
- Department of Cardiology, Faculty of Medicine, The University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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26
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Betigeri VM, Betigeri AV, Karthikeyan B, SubbaRao KSVK. Rheumatic mitral stenosis associated with sinus venosus atrial septal defect and partial anomalous pulmonary venous return. Gen Thorac Cardiovasc Surg 2013; 63:361-4. [PMID: 23897292 DOI: 10.1007/s11748-013-0293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2013] [Accepted: 07/13/2013] [Indexed: 11/29/2022]
Abstract
In medical literature, the association of acquired and congenital heart disease is interestingly well known, but uncommon. We report a case of young male adult whose therapeutic management for rheumatic mitral stenosis is changed as sinus venosus atrial septal defect was detected by transesophageal echocardiography. Presence of partial anomalous pulmonary venous return of right superior pulmonary vein into the superior vena cava detected in transesophageal echocardiography was confirmed at the operation which was successfully carried out to correct all three abnormalities through the right atrial approach.
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27
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Pagel PS, Johnson KR, Nicolosi AC. Dizziness Leads to an Unexpected Diagnosis. J Cardiothorac Vasc Anesth 2012; 26:975-7. [DOI: 10.1053/j.jvca.2012.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Indexed: 11/11/2022]
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28
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Kuzumi C, Frogel J, Applefield D. Aberrant azygos vein complicating postatrial septal defect repair intraoperative echocardiography examination. Anesth Analg 2011; 112:800-2. [PMID: 21385978 DOI: 10.1213/ane.0b013e31820cedc3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Chika Kuzumi
- Department of Anesthesiology, Henry Ford Hospital, Detroit, Michigan, USA
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29
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Perez L, Razzouk A, Bansal RC. Real time three-dimensional transesophageal echocardiographic evaluation of a sinus venosus atrial septal defect. Echocardiography 2010; 28:E82-4. [PMID: 20868438 DOI: 10.1111/j.1540-8175.2010.01314.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We present a case of a 65-year-old man who presented with atrial flutter and dilation of right heart was noted on transthoracic echocardiography. Transesophageal echocardiography revealed a large sinus venosus atrial septal defect close to superior vena cava and anomalous connection of right superior pulmonary vein. Additionally, real time three-dimensional transesophageal echocardiography provided superior spatial details and demonstrated the size, location of the defect and its spatial relationship to the surrounding structures. Patient underwent successful surgical repair.
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Affiliation(s)
- Leandro Perez
- Division of Cardiology, Loma Linda University School of Medicine, Loma Linda, California 92354, USA
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30
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Prompona M, Muehling O, Naebauer M, Schoenberg SO, Reiser M, Huber A. MRI for detection of anomalous pulmonary venous drainage in patients with sinus venosus atrial septal defects. Int J Cardiovasc Imaging 2010; 27:403-12. [PMID: 20686854 DOI: 10.1007/s10554-010-9675-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Accepted: 07/24/2010] [Indexed: 11/27/2022]
Affiliation(s)
- Maria Prompona
- Institute of Clinical Radiology, Campus Grosshadern, University of Munich, Marchioninistr. 15, 81377 Munich, Germany.
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31
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Gulati GS, Hoey ETD, Gopalan D, Agrawal BSK, Screaton NJ. Sinus venosus atrial septal defect in adults: utility of cardiovascular MRI in resolving this diagnostic dilemma. Heart Lung Circ 2010; 19:615-9. [PMID: 20655279 DOI: 10.1016/j.hlc.2010.06.666] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 05/27/2010] [Accepted: 06/07/2010] [Indexed: 12/01/2022]
Abstract
Sinus venosus atrial septal defect (SV-ASD) can be a challenging diagnostic problem. It can present with non-specific signs and symptoms and, on imaging, can mimic other causes of right heart dilatation. Transthoracic echocardiography using standard scan planes may be limited, due to the defect and any associated anomalous pulmonary venous drainage lying outside the confines of the fossa ovalis. At our institution, we use cardiovascular magnetic resonance imaging (CMRI) as a problem-solving tool in these patients. In this article, we discuss the utility of CMRI in establishing the diagnosis by presenting our recent experience and illustrating it with sample cases. We wish to highlight the problems relating to making a diagnosis of SV-ASD in adult patients, and how CMRI has contributed to overcoming these in our practice.
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32
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Foo D, Chia PL. Unusual Pacemaker Lead Placement in an Unsuspecting Heart. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2010. [DOI: 10.47102/annals-acadmedsg.v39n7p586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Riesenkampff EMC, Schmitt B, Schnackenburg B, Huebler M, Alexi-Meskishvili V, Hetzer R, Berger F, Kuehne T. Partial anomalous pulmonary venous drainage in young pediatric patients: the role of magnetic resonance imaging. Pediatr Cardiol 2009; 30:458-64. [PMID: 19184180 DOI: 10.1007/s00246-008-9367-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 12/22/2008] [Indexed: 11/25/2022]
Abstract
Studies of larger patient groups for systematic assessment of the anatomical accuracy of magnetic resonance imaging (MRI) for partial anomalous pulmonary venous drainage (PAPVD) have been performed so far only in adults. This study was undertaken to evaluate whether MRI can precisely depict pulmonary venous anatomy in infants and young children. Data on 26 children under 10 years old that underwent MRI over the past 2 years for suspected PAPVD were assessed. The MRI protocol included shunt quantification by velocity-encoded cine as well as morphological and functional assessment by multislice multiphase and contrast-enhanced MR techniques. MRI was performed in the compliant patient in breath-hold (n = 8; age range, 4.6-9.5 years) and in the noncompliant patient in conscious-sedation free breathing (n = 18; age range, 0.4 to 7.5 years). In 22 patients, PAPVD was diagnosed with MRI and confirmed during surgery. In four patients with large atrial septal defects not accessible to percutaneous closure, normal pulmonary venous return was demonstrated by MRI and confirmed during surgery. MRI under conscious sedation accurately specifies the anatomy of pulmonary veins in infants and small children. Therefore, we suggest performing MRI in patients with inconclusive transthoracic echocardiographic results in the preoperative assessment of PAPVD.
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34
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Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA, Del Nido P, Fasules JW, Graham TP, Hijazi ZM, Hunt SA, King ME, Landzberg MJ, Miner PD, Radford MJ, Walsh EP, Webb GD. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2009; 52:e143-e263. [PMID: 19038677 DOI: 10.1016/j.jacc.2008.10.001] [Citation(s) in RCA: 977] [Impact Index Per Article: 65.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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35
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Sengupta PP, Khandheria BK. Transesophageal Echocardiography: Principles and Application. Echocardiography 2009. [DOI: 10.1007/978-1-84882-293-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Cho HJ, Chung WJ, Bong JM, Shin KC, Shin MS, Kang WC, Han SH, Moon CI, Koh KK, Ahn TH, Choi IS, Shin EK. Inferior Sinus Venosus Type Atrial Septal Defect Initially Presenting Pulmonary Hypertension on Transthoracic Echocardiography. J Cardiovasc Ultrasound 2009. [DOI: 10.4250/jcu.2009.17.1.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hyon Joung Cho
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Jeong Min Bong
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Kwen-Chul Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Woong Chol Kang
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Seung Hwan Han
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Chan Il Moon
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Kwang Kon Koh
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Tae Hoon Ahn
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - In Suck Choi
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Eak Kyun Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Hospital, Incheon, Korea
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Cardiac MRI and Pulmonary MR Angiography of Sinus Venosus Defect and Partial Anomalous Pulmonary Venous Connection in Cause of Right Undiagnosed Ventricular Enlargement. AJR Am J Roentgenol 2009; 192:259-66. [PMID: 19098208 DOI: 10.2214/ajr.07.3430] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Atypical atrial septal defects in children: noninvasive evaluation by cardiac MRI. Pediatr Radiol 2008; 38:1188-94. [PMID: 18787816 DOI: 10.1007/s00247-008-0977-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/21/2008] [Accepted: 06/22/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atypical left-to-right shunts at the level of the atrium in children such as sinus venosus atrial septal defects (ASDs) and partial anomalous pulmonary venous return (PAPVR) may be difficult to assess by transthoracic or transoesophageal echocardiography. Free-breathing cardiac MRI may be a powerful alternative. OBJECTIVE To assess the value of free-breathing cardiac MRI in the delineation of atypical ASDs in children. MATERIALS AND METHODS A total of 82 children (mean age 5.9 years, range 1.1-15.7 years) with suspected ASD and inconclusive transthoracic echocardiography underwent cardiac MRI under free-breathing, mostly sedated conditions. Phase-contrast MRI was used for defect visualization and shunt quantification, and multiphase inflow MR angiography for delineation of pulmonary/systemic venous connections. RESULTS Of the 82 patients, 34 (41%) were diagnosed with atypical shunt lesions at the level of the atrium and 48 (59%) with simple secundum ASDs. No false-negative or false-positive findings were reported by MRI compared to cardiac catheterization and intraoperative findings. Superior sinus venosus ASD with partial anomalous PAPVR was present in 10 of the 82 children (12.2%), whereas 2 (2.4%) had a large posterior-inferior defect, 5 (6.1%) had isolated PAPVR, and 17 (20.7%) had multiple ASDs and/or associated vascular anomalies. Q(p)/Q(s) by phase-contrast MRI agreed well with oximetry values (mean difference 3%, limits of agreement +/-21-25%; Bland/Altman analysis). CONCLUSION Free-breathing cardiac MRI under sedation allows reliable identification of atypical left-to-right shunt defects at the level of the atrium in children in whom transcatheter ASD closure is unsuitable, including delineation of pulmonary or systemic venous anomalies and shunt quantification.
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39
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Rheault M, Alfirevic A, Mossad EB. An unusual case of postoperative hypoxemia diagnosed with transesophageal echocardiography. Anesth Analg 2008; 107:1506-8. [PMID: 18931206 DOI: 10.1213/ane.0b013e318183902b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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40
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Fang F, Lam YY, Li ZA, Yang Y, Chan YS, Yu CM. Identification of unusual conditions after atrial septal defect repair by systematic transthoracic echocardiographic assessment. Echocardiography 2008; 25:1094-100. [PMID: 18771546 DOI: 10.1111/j.1540-8175.2008.00727.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a lack of echocardiographic studies to address the detection of atrial masses and abnormal venous connections in patients with secundum atrial septal defect (ASD) repair. This study sought to demonstrate that with proper technique, these unusual conditions could be diagnosed confidently by transthoracic echocardiography. METHOD We performed a retrospective review of all repaired ASD patients of all ages with follow-up echocardiography done at Beijing Anzhen Hospital from year 1999 to 2005. Clinical and echocardiographic features of patients with aforementioned conditions were evaluated. RESULTS Systematic echocardiographic protocol identified 11 patients with unusual conditions, in whom four patients had atrial masses (three atrial thrombi, one inflammatory pseudotumor) and seven patients had abnormal venous connections (two inadvertent diversion of inferior vena cava to left atrium, five previously unrecognized partial anomalous pulmonary venous connections). CONCLUSION Atrial masses and abnormal venous connections could be diagnosed through a systematic echocardiographic approach in evaluating patients with ASD repair.
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Affiliation(s)
- Fang Fang
- Ultrasound Department, Beijing AnZhen Hospital, Capital Medical University, Beijing, China. fangfang
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41
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Kharouf R, Luxenberg DM, Khalid O, Abdulla R. Atrial septal defect: spectrum of care. Pediatr Cardiol 2008; 29:271-80. [PMID: 17955282 DOI: 10.1007/s00246-007-9052-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2007] [Revised: 05/15/2007] [Accepted: 07/03/2007] [Indexed: 11/25/2022]
Abstract
Atrial septal defect (ASD) is a common congenital heart defect. Variability in management of this lesion exists among clinicians. A review of the literature reveals that there is lack of standard guidelines for the evaluation and management of patients with different types of ASDs. This survey-based study was conducted to test the uniformity of diagnostic and therapeutic approach to management of children with secundum, sinus venosus, and primum ASDs. Survey questionnaires were prepared to include questions regarding follow-up, diagnosis, and therapeutic intervention of different types and sizes of ASDs. Questions addressed follow-up visitations, type and frequency of investigative studies, pharmacological therapy, and choice of repair method. Surveys were sent out to all pediatric cardiology academic programs in the United States (n=48) and randomly selected international programs from Europe, Asia, and Australia (n=19). A total of 23 programs (34%) responded to the survey (15 from the United States and 8 internationally). A separate questionnaire was prepared for secundum, primum, and sinus venosus ASD. In each questionnaire, lesion types were subdivided into small, moderate, and large defect sizes to address differences of management approaches to each defect type and size. Results indicate that in secundum ASD, most participants use size of the defect and/or evidence of right-sided volume overload as criteria for defining small, moderate, and large defects. Frequency of follow-up does not vary with the type of lesion but is more frequent with larger defects. Most participants see patients with small defects at intervals of 6 months to 1 year and those with large defects at 3- to 6-month intervals. Age of patient and presence of symptoms determined the frequency of follow-up across all defects. Echocardiography was the most frequently used investigative modality in all defect sizes and types during follow-up visits (used by >80% for follow-up), followed by electrocardiography (ECG). There is a striking preference for the use of pharmacological therapy in primum ASD compared with secundum and sinus venosus ASD. The timing of repair was mainly dependent on patient age and symptomatology in different defects, with the presence of associated anomalies contributing to that in primum and sinus venosus ASD. Most participants use percutaneous approach to close secundum ASD (either as a first choice or as one of two choices depending on the presence of certain features). Before repair, participants use MRI or cardiac catheterization to fully evaluate a secundum ASD if it is large. These investigative modalities are not commonly used in primum and sinus venosus ASD. There is agreement on postoperative follow-up in different types of defects, with most participants continuing follow-up indefinitely, especially in larger defects.
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Affiliation(s)
- R Kharouf
- The University of Chicago, MC 4051, Chicago, Illinois 60637-1470, USA.
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Huang X, Huang Y, Huang T, Huang W, Huang Z. Individual pulmonary vein imaging by transthoracic echocardiography: an inadequate traditional interpretation. ACTA ACUST UNITED AC 2008; 9:655-60. [DOI: 10.1093/ejechocard/jen032] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Valente AM, Sena L, Powell AJ, Del Nido PJ, Geva T. Cardiac magnetic resonance imaging evaluation of sinus venosus defects: comparison to surgical findings. Pediatr Cardiol 2007; 28:51-6. [PMID: 17318709 DOI: 10.1007/s00246-006-1477-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 08/29/2006] [Indexed: 10/23/2022]
Abstract
Sinus venosus defect (SVD) is an uncommon type of interatrial communication in which cardiac magnetic resonance (CMR) is increasingly used as an alternative imaging modality. The goal of this study was to determine the accuracy of CMR in patients with SVD compared with surgical findings. The diagnostic studies and operative reports of all patients who had CMR followed by surgical repair of SVD (n = 16) from 1996 to 2005 were reviewed and discrepancies were recorded. CMR studies included assessment of anatomy (evaluated by a combination of gradient echo cine, spin echo, and gadolinium-enhanced three-dimensional magnetic resonance angiography), ventricular volumes and function, and flow measurements. The median age at CMR was 14 years (range, 0.4-42). Compared with operative findings, there were no major discrepancies with CMR. The SVD was clearly imaged in all patients and 36 anomalously draining pulmonary veins were identified. The median pulmonary-to-systemic flow ratio was 2.4 (range, l.3-4.6). Patients had an average of 1.7 previous diagnostic tests (range, 1-3; 19 transthoracic echo, 5 catheterizations, and 3 transesophageal echo). Before CMR, SVD was diagnosed in 1 patient, suspected in 7, and not suspected in 8. Additional unsuspected findings identified by CMR included malposition of septum primum (n = 2), left superior vena cava to coronary sinus (n = 2), and aortic arch anomalies (n = 2). CMR accurately depicts SVD anatomy and associated anomalous pulmonary venous drainage, provides quantitative information on the hemodynamic burden, and reveals additional cardiovascular abnormalities. This experience indicates that CMR provides the information necessary for surgical planning of SVD repair.
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Affiliation(s)
- Anne Marie Valente
- Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA
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Echocardiography in the Adult with Congenital Heart Disease. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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45
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Nusser T, Höher M, Merkle N, Grebe OC, Spiess J, Kestler HA, Rasche V, Kochs M, Hombach V, Wöhrle J. Cardiac Magnetic Resonance Imaging and Transesophageal Echocardiography in Patients With Transcatheter Closure of Patent Foramen Ovale. J Am Coll Cardiol 2006; 48:322-9. [PMID: 16843183 DOI: 10.1016/j.jacc.2006.03.036] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Revised: 03/01/2006] [Accepted: 03/28/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We studied the value of cardiac magnetic resonance imaging (CMRI) before and after closure of patent foramen ovale (PFO) in patients with cryptogenic ischemic events. BACKGROUND Cardiac magnetic resonance imaging is a powerful noninvasive tool for detailed assessment of cardiac anatomy and function. The relevance of CMRI compared with transesophageal echocardiography (TEE) in patients undergoing transcatheter PFO closure has not been evaluated so far. METHODS Contrast-enhanced CMRI and TEE were performed in 75 patients before and after PFO closure. Twelve months after PFO closure, both imaging techniques were repeated in 61 patients with contrast application. To determine provokable atrial right-to-left shunting in CMRI, we applied a contrast-enhanced perfusion imaging technique. Detection of atrial septal aneurysm (ASA) was achieved by means of a high-resolution cine imaging technique. RESULTS Before PFO closure, ASA was seen with CMRI in 28 of 75 cases (37.3%), compared with 47 of 75 (62.7%) cases using TEE. There were a total of 211 CMRI studies with a corresponding TEE performed in 75 patients. No shunt was present in 107 of 211 studies with both techniques. Contrast-enhanced right-to-left shunting was detected by CMRI in 48 of 72 (66.6%) cases with moderate or severe shunts seen with TEE, but only in 6 of 32 (18.8%) studies with mild shunts with TEE. Anomalous venous returns were excluded in all patients. In two patients, coronary anomalies were seen. CONCLUSIONS The present CMRI technique is inferior to TEE in detection of contrast-enhanced right-to-left shunting and identification of ASA.
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Affiliation(s)
- Thorsten Nusser
- Department of Internal Medicine II-Cardiology, University of Ulm, Ulm, Germany
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46
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Chetboul V, Charles V, Nicolle A, Sampedrano CC, Gouni V, Pouchelon JL, Tissier R. Retrospective Study of 156 Atrial Septal Defects in Dogs and Cats (2001-2005). ACTA ACUST UNITED AC 2006; 53:179-84. [PMID: 16629951 DOI: 10.1111/j.1439-0442.2006.00813.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Atrial septal defect (ASD) is a common congenital heart disease (CHD) in humans, but considered relatively rare in veterinary medicine. However, modern echocardiographic and Doppler techniques currently offer a good view of the morphology of the interatrial septum, thus facilitating earlier detection of ASD in awake animals. In this context, we carried out a retrospective study of cases of recently diagnosed ASD in dogs and cats at the Cardiology Unit of Alfort (2001-2005) using echocardiography combined with colour Doppler mode. ASD was diagnosed in 156 animals and represented 37.7% of all canine and feline CHDs (n = 414). ASD was the most common CHD after mitral dysplasia in both species. Boxer and Domestic shorthair were the most common canine and feline breeds affected. Most defects (98.7%) were secundum-type ASD, without clinical signs in 73.7% of cases. The most common clinical signs included systolic murmur heard over the left heart base (20.2%), exercise intolerance (7.0%), syncope (5.3%), dyspnoea (2.6%) and cough (2.6%). Animals that presented a systolic heart murmur over the left base had a significantly larger ASD than others (P < 0.05). These data suggest that the incidence of ASD is higher than previously assumed. ASD should be suspected, for example, in instances of left basal systolic heart murmur, although its clinical and haemodynamic consequences are usually minor.
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Affiliation(s)
- V Chetboul
- Pharmacy-Toxicology Unit of Alfort, INSERM U660, National Veterinary School of Alfort, 7 Avenue du General de Gaulle, 94704 Maisons-Alfort Cedex, France.
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47
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Affiliation(s)
- Partho P Sengupta
- The Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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48
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Pua EC, Idriss SF, Wolf PD, Smith SW. Real-time 3D transesophageal echocardiography. ULTRASONIC IMAGING 2004; 26:217-232. [PMID: 15864980 DOI: 10.1177/016173460402600402] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Transesophageal echocardiography (TEE) is an essential diagnostic tool in patients with poor transthoracic echocardiographic windows or when detailed imaging of structures distant from the chest wall is necessary. A real-time 3D TEE probe has been fabricated in our laboratory in order to increase the amount of information available during a transesophageal procedure. The 1 cm diameter esophageal probe utilizes a 2-dimensional, 5 MHz array at its tip with a 6.3 mm diameter aperture, including 504 active channels. The array has a periodic vernier geometry with an element pitch of 0.18 mm, built onto a multilayer flexible (MLF) interconnect circuit. In order to accommodate 504 channels within the device, a 1 m long Gore MicroFlat cable was utilized for wiring the MLF to the corresponding system connectors. Pulse-echo tests in a water tank have yielded a -6 dB bandwidth of 25.3%. Fully connected to the system through 3 m of cable, the probe shows an average 50 omega insertion loss of-85 dB with a standard deviation of 4 dB, as determined through pitch-catch measurements for a sampling of 10 elements. Using the completed 3D TEE probe with the Volumetrics Medical Imaging 3D scanner, real-time volumetric images of in vivo canine cardiac anatomy have been acquired, displaying atrial views, mitral valve function and interventional catheter guidance.
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Affiliation(s)
- Eric C Pua
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.
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49
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Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M. Venous Anomalies of the Thorax. AJR Am J Roentgenol 2004; 182:1139-50. [PMID: 15100109 DOI: 10.2214/ajr.182.5.1821139] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Terrence C Demos
- Department of Radiology, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153, USA
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50
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Gaibazzi N, Montresor G, Poeta ML. Anatomy of a wrong diagnosis: false sinus venosus atrial septal defect. Cardiovasc Ultrasound 2003; 1:15. [PMID: 14613576 PMCID: PMC270092 DOI: 10.1186/1476-7120-1-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2003] [Accepted: 11/07/2003] [Indexed: 11/13/2022] Open
Abstract
In contrast with transthoracic echocardiography, transesophageal echocardiography provides a sure way to make the diagnosis of sinus venosus atrial septal defect; on the other hand this abnormality is more complex than that seen with the secundum atrial septal defect, and inexperienced operators may fail to recognize properly the defect. In front of a high reported sensitivity using transesophageal echocardiography, specificity is difficult to assess, due to possible underreporting of diagnostic errors. We describe a false positive diagnosis of sinus venosus atrial septal defect, in the setting of enlarged right chambers of the heart because of pressure overload. Modified anatomy of the heart, together with the presence of a prominent linear structure(probably Eustachian Valve) and an incomplete examination in this case made image interpretation very prone to misinterpretation. In this anatomical setting transesophageal longitudinal "bicaval" view may be sub-optimal for examining the atrial septum, potentially showing false images that need to be known for correct image interpretation. Nonetheless, a scan plane taken more accurately at the superior level would have demonstrated/excluded the pathognomonic feature of sinus venosus atrial septal defect in the high atrial septum, between the fatty limbus and the inferior aspect of the right pulmonary artery; moreover TEE allows morphological information about the posterior structures of the heart that need to be investigated in detail for a complete diagnosis.
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Affiliation(s)
- Nicola Gaibazzi
- Department of Cardiology, Ospedale Civile di Desenzano del Garda-Desenzano del Garda(BS), Italy
| | - Graziano Montresor
- Department of Cardiology, Ospedale Civile di Desenzano del Garda-Desenzano del Garda(BS), Italy
| | - Maria Luisa Poeta
- Department of Cardiology, Ospedale Civile di Desenzano del Garda-Desenzano del Garda(BS), Italy
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