Echocardiographic Identification of an Interrupted Inferior Vena Cava with Dilated Azygos Vein During Coronary Artery Bypass Graft Surgery

Case Report: Incidental finding of an atresia of the inferior vena cava-a challenge for cardiac surgery

Inferior vena cava atresia is a rare and usually asymptomatic condition. However, when these patients undergo cardiac surgery, it can present an unexpected and challenging situation for the surgeon. Specifically, adequate venous drainage during cardiopulmonary bypass (CPB) is a critical issue here and may require an extension of cannulation strategies. Adequate preoperative diagnostics, ideally with imaging modalities such as CT angiography or MRI, are required for optimal surgical planning. Here, we describe a rare case of thoracic ascending aortic aneurysm with concomitant inferior vena cava atresia that was successfully operated on. With adequate preoperative planning, we were able to perform an operation without unforeseen complications with standard initialization of CPB.

Venous Cannulation for Cardiopulmonary Bypass in the Case of Anomaly of the Inferior Vena Cava

Congenital anomalies of the inferior vena cava and its tributaries are quite uncommon; however, since the development of cross-sectional imaging, they have been described more frequently. Most of them are usually asymptomatic, although they can have clinical implications. We report a case of a rare anomaly of the inferior vena cava in a 54-year-old man admitted to our hospital for complicated native aortic valve endocarditis, requiring urgent surgery, and making necessary an alternative venous cannulation for establishing cardiopulmonary bypass circulation.

A Unique Variation of Azygos System of Veins

Knowledge of variations of azygos and hemiazygos veins is of importance to cardiothoracic surgeons and radiologists during various surgical, radiological, and echography techniques. We report some unique variations of azygos system of veins observed during dissection classes for undergraduate medical students. The azygos vein was formed as usual by the union of right subcostal and ascending lumbar veins. The vein ascended upward and to the left to reach the midline at the level of the 9^th thoracic vertebra. After ascending till 5^th thoracic vertebra, it gradually inclined to the right of midline and terminated by opening into the superior vena cava at the level of the 3^rd thoracic vertebra. There was no major variation in the tributaries of the azygos vein on the right side, except that the right superior intercostal vein crossed behind the azygos vein from right to left and opened into the left side of the azygos vein. Further, two anastomotic veins connected the 10^th, 11^th and 12^th posterior intercostal veins with each other to form two anastomotic circles on the right side of 10^th to 12^th thoracic vertebrae. The hemiazygos vein bifurcated on the left side of the 10^th thoracic vertebra and the two ends opened into the azygos vein at the level of 9^th and 10^th thoracic vertebrae forming a venous circle in front of the 10^th thoracic vertebra. The course of accessory hemiazygos vein was noteworthy. Instead of its classic descending course, the vein ascended upward from the left side of the 8^th thoracic vertebra till the 6^th thoracic vertebra before opening into the azygos vein.