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Buech J, Radner C, Fabry T, Rutkowski S, Hagl C, Peterss S, Pichlmaier MA. Case Report: Incidental finding of an atresia of the inferior vena cava-a challenge for cardiac surgery. Front Cardiovasc Med 2024; 11:1321685. [PMID: 38380181 PMCID: PMC10876821 DOI: 10.3389/fcvm.2024.1321685] [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: 10/14/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
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.
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Affiliation(s)
- Joscha Buech
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- University Aortic Center Munich (LMU), LMU University Hospital, Munich, Germany
| | - Caroline Radner
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- University Aortic Center Munich (LMU), LMU University Hospital, Munich, Germany
| | - Thomas Fabry
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- University Aortic Center Munich (LMU), LMU University Hospital, Munich, Germany
| | - Simon Rutkowski
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- University Aortic Center Munich (LMU), LMU University Hospital, Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
- University Aortic Center Munich (LMU), LMU University Hospital, Munich, Germany
| | - Sven Peterss
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- University Aortic Center Munich (LMU), LMU University Hospital, Munich, Germany
| | - Maximilian A. Pichlmaier
- Department of Cardiac Surgery, LMU University Hospital, Munich, Germany
- University Aortic Center Munich (LMU), LMU University Hospital, Munich, Germany
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Venous Cannulation for Cardiopulmonary Bypass in the Case of Anomaly of the Inferior Vena Cava. Ann Thorac Surg 2017; 105:e23-e24. [PMID: 29233357 DOI: 10.1016/j.athoracsur.2017.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/20/2022]
Abstract
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.
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Abstract
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 9th thoracic vertebra. After ascending till 5th thoracic vertebra, it gradually inclined to the right of midline and terminated by opening into the superior vena cava at the level of the 3rd 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 10th, 11th and 12th posterior intercostal veins with each other to form two anastomotic circles on the right side of 10th to 12th thoracic vertebrae. The hemiazygos vein bifurcated on the left side of the 10th thoracic vertebra and the two ends opened into the azygos vein at the level of 9th and 10th thoracic vertebrae forming a venous circle in front of the 10th 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 8th thoracic vertebra till the 6th thoracic vertebra before opening into the azygos vein.
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Affiliation(s)
- Satheesha Nayak Badagabettu
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India
| | - Prakashchandra Shetty
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India
| | - Melanie Rose D'Souza
- Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India
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