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Yousefi A, Salehi S, Radgoodarzi M, Javid A. Association of autoimmune pancreatitis with Raghib syndrome. Clin Case Rep 2023; 11:e8194. [PMID: 38116515 PMCID: PMC10728366 DOI: 10.1002/ccr3.8194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2023] [Accepted: 05/05/2023] [Indexed: 12/21/2023] Open
Abstract
Key Clinical Message Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis scarcely found in children. Raghib syndrome is a rare congenital heart defect known as persistent left superior vena cava (LSVC) draining into the left atrium. Total signs of Raghib syndrome in AIP case accompanied by an IgG4-related disease were described. Abstract Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis scarcely found in children. Raghib syndrome is a rare congenital heart defect known as persistent left superior vena cava (LSVC) draining into the left atrium. Here, we describe Raghib syndrome in AIP case accompanied by an IgG4-related disease (AIP/IgG4RD). A 13-year-old boy presented with a 3-month history of fever and abdominal pain. The laboratory findings showed SGOT and SGPT, ALP was increased, while amylase and γ-GT were normal. Immunoglobulins were normal, except for IgG. Endosonography, spiral CT of the abdomen, and cholangiopancreatography showed an enlargement of the pancreas. Contrast echocardiography discovered opacification of the coronary sinus and left atrium. Transesophageal echocardiography for LSVC revealed a dilatation in the coronary sinus, indicating persistent LSVC. Following the injection of agitated saline into the left antecubital vein, bubbles entered both left and right atria in LSVC. It is reasonable to exclude some of these rare disorders as Raghib syndrome, in cases that will be started on medications like corticosteroids, which increases the susceptibility to thromboembolic events.
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Affiliation(s)
- Azizollah Yousefi
- Department of PediatricsHazrat‐e‐Rasool General HospitalIran University of Medical ScienceTehranIran
| | - Shima Salehi
- Department of PediatricsHazrate Ali Asghar Children HospitalIran University of Medical ScienceTehranIran
| | - Mohammad Radgoodarzi
- Department of PediatricsHazrat‐e‐Rasool General HospitalIran University of Medical ScienceTehranIran
| | - Asma Javid
- Department of PediatricFirouzabadi Clinical Research Development UnitIran University of Medical SciencesTehranIran
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2
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Agstam S, John L, Ramakrishnan S, Gupta SK. Recanalized vein of marshall following bidirectional glenn surgery. J Invasive Cardiol 2023; 35. [PMID: 37984331 DOI: 10.25270/jic/23.00182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
A 6-year-old boy with a case of double outlet right ventricle with large non-routable ventricle septal defect and severe pulmonary stenosis was deemed unsuitable for biventricular repair on a prior evaluation. Hence, a bidirectional Glenn (BDG) shunt was performed at 3 years of age following cardiac catheterization.
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Affiliation(s)
- Sourabh Agstam
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Lydia John
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
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3
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Jacon P, Venier S, Carabelli A, Rees T, Maigron M, Peter P, Deschamps E, Desbiolles A, Ndiaye M, Defaye P. Posteroseptal Accessory Pathway Ablation Via a Left Superior Vena Cava and Retrograde Coronary Sinus Approach. JACC Clin Electrophysiol 2023; 9:1428-1432. [PMID: 37086225 DOI: 10.1016/j.jacep.2023.01.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/29/2022] [Accepted: 01/29/2023] [Indexed: 04/23/2023]
Affiliation(s)
- Peggy Jacon
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France.
| | - Sandrine Venier
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Adrien Carabelli
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Thomas Rees
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Manon Maigron
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Paul Peter
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Elodie Deschamps
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Antoine Desbiolles
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Malick Ndiaye
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
| | - Pascal Defaye
- Department of Cardiology, University Hospital of Grenoble Alpes, Grenoble, France
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4
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Mohammad Nijres B, Reinking B, Aldoss O. Left atrial appendage occlusion using hydrogel coils in a child. Catheter Cardiovasc Interv 2023; 101:1230-1234. [PMID: 37070477 DOI: 10.1002/ccd.30657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/13/2023] [Accepted: 03/24/2023] [Indexed: 04/19/2023]
Abstract
Left atrial appendage occlusion in young children has not been reported before. Herein, we describe a successful occlusion using hydrogel coils in a toddler. The decision to occlude the appendage was made to mitigate the potential risk of systemic thromboembolism, given the child's unusual anatomy.
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Affiliation(s)
- Bassel Mohammad Nijres
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Benjamin Reinking
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Osamah Aldoss
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
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5
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Farruggio S, Caruso E. Multiple ventricular septal defects associated to anomalous venous returns, mitral valve disease, myocardium hypertrophy, and right outflow obstruction: a multimodality imaging assessment. Echocardiography 2023; 40:379-384. [PMID: 36880641 DOI: 10.1111/echo.15551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 01/11/2023] [Accepted: 02/13/2023] [Indexed: 03/08/2023] Open
Abstract
We report a rare congenital heart disease characterized by multiple ventricular septal defects associated to anomalous systemic and pulmonary venous returns, marked apical myocardial hypertrophy of both ventricles and of right outflow, and hypoplastic mitral anulus. Multimodality imaging is mandatory to assess anatomical details.
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Affiliation(s)
- Silvia Farruggio
- Mediterranean Pediatric Cardiology Center "Bambino Gesù", San Vincenzo Hospital, Taormina, Italy
| | - Elio Caruso
- Mediterranean Pediatric Cardiology Center "Bambino Gesù", San Vincenzo Hospital, Taormina, Italy
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6
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Trehan V, Safal, Gautam A, Bansal A. Transhepatic balloon mitral valvotomy in mitral stenosis with interrupted inferior vena cava. Catheter Cardiovasc Interv 2022; 100:256-260. [PMID: 35634757 DOI: 10.1002/ccd.30240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/07/2022]
Abstract
A 38-year-old female was found to have severe mitral stenosis, severe pulmonary arterial hypertension with moderate tricuspid regurgitation, dilated right atrium, persistent left superior vena cava, and hugely dilated coronary sinus. The scheduled balloon mitral valvotomy via trans-femoral approach was abandoned after the venogram revealed the presence of left-sided inferior vena cava with hemi-azygos continuation draining into coronary sinus via left-sided superior vena cava. Balloon mitral valvotomy was attempted from the right trans-jugular route, but we were unable to puncture the inter-atrial septum due to the hugely dilated coronary sinus and right atrium. A transhepatic approach was used and balloon mitral valvotomy was successfully done with a standard balloon of 24 mm size without any complication. In patients with inferior vena cava anomalies or interruption, a percutaneous transhepatic approach is a feasible alternative for performing balloon mitral valvotomy.
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Affiliation(s)
- Vijay Trehan
- Department of Cardiology, G.B. Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Safal
- Department of Cardiology, G.B. Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ankur Gautam
- Department of Cardiology, G.B. Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Ankit Bansal
- Department of Cardiology, G.B. Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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7
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Darbari A, Sharma G, Patil PL, Kumar B, Sharma R. Cardiac Computed Tomography as a Diagnostic Modality for the Assessment of Complex Congenital Heart Disease Management. Cureus 2021; 13:e16838. [PMID: 34513427 PMCID: PMC8410508 DOI: 10.7759/cureus.16838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 12/02/2022] Open
Abstract
Here, we present a case of partial anomalous pulmonary venous return with the superior type of sinus venosus atrial septal defect. This case also had unusually persistent left-sided superior vena cava, which could not be diagnosed well in preoperative transthoracic echocardiography and required contrast-enhanced cardiac computed tomography scanning for proper diagnosing, operative planning, and avoidance of intraoperative problems. Postoperative, cardiac computed tomography scanning was also done to confirm adequate management.
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Affiliation(s)
- Anshuman Darbari
- Department of Cardiothoracic & Vascular Surgery (CTVS), All India Institute of Medical Sciences, Rishikesh, IND
| | - Garima Sharma
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh, IND
| | - Prashant L Patil
- Department of Cardiothoracic & Vascular Surgery (CTVS), All India Institute of Medical Sciences, Rishikesh, IND
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences, Rishikesh, IND
| | - Rahul Sharma
- Department of Cardiothoracic & Vascular Surgery (CTVS), All India Institute of Medical Sciences, Rishikesh, IND
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8
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Gourav KP, Rao V, Negi S, Karri S. Modified bi-caval view-An ideal view for diagnosing left superior vena cava with large left innominate vein on saline contrast echocardiography. J Clin Ultrasound 2021; 49:420-422. [PMID: 33022108 DOI: 10.1002/jcu.22933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 08/25/2020] [Accepted: 09/20/2020] [Indexed: 06/11/2023]
Abstract
Left superior vena cava (LSVC) is the most common congenital thoracic venous anomaly which commonly drains into the right atrium via the coronary sinus. Various clinical implications are associated with LSVC and is commonly diagnosed with saline contrast echocardiography. In this case we discuss the importance of a modified bi-caval view over the mid-oesophageal four-chamber view in diagnosing LSVC with the large left innominate vein.
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Affiliation(s)
- Krishna Prasad Gourav
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Veerabhadra Rao
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunder Negi
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sujitha Karri
- Department of Anaesthesia & Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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9
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Rahil MA, Hadjmhamed M. Nephronophthisis and central veins abnormalities: A case report. Clin Case Rep 2021; 9:1977-1979. [PMID: 33936626 PMCID: PMC8077304 DOI: 10.1002/ccr3.3920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/02/2020] [Accepted: 01/29/2021] [Indexed: 11/11/2022] Open
Abstract
Patients with genetic disorders are potentially more susceptible to present vascular abnormalities compared to the general population. For these patients, unusual difficulties could appear during a CVC placement procedure that could lead to major complications if venous abnormalities are undiagnosed. Ultrasound and fluoroscopy guidance should be used routinely for all patients in order to avoid complications and catheter misplacement.
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10
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Khadkikar G, V SM, Patel A, Shah SC, Patel TM. A Rare Case of an Unroofed Coronary Sinus With a Persistent Left Superior Vena Cava Diagnosed by Two-Dimensional Transthoracic Echocardiography. Cureus 2021; 13:e13041. [PMID: 33680587 PMCID: PMC7925216 DOI: 10.7759/cureus.13041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
An unroofed coronary sinus is a rare congenital anomaly in the roof of the coronary sinus causing a communication between the coronary sinus and the left atrium leading to a left to right shunt. It is often associated with a persistent left superior vena cava and other complex congenital lesions like anomalous pulmonary venous return and heterotaxy. Since it is a deep-seated defect, it is seldom diagnosed by transthoracic two-dimensional (2D) echocardiography and requires multimodal imaging for a diagnosis. Here, we present the case of a 27-year-old male in whom the defect was very apparent on standard 2D transthoracic echocardiography. Transthoracic 2D echocardiography revealed situs solitus, levocardia, and a dilated coronary sinus with unroofing which was most prominent in the standard parasternal long-axis view and the foreshortened apical four-chamber view. A color Doppler demonstrated a flow from the left atrium into the dilated coronary sinus. The right ventricle and atrium were dilated with mild pulmonary arterial hypertension. There was no right ventricular dysfunction. Examination with modified suprasternal views showed a left superior vena cava. All four pulmonary veins drained into the left atrium. Other chambers of the heart and great vessels were structurally normal without coarctation or patent ductus arteriosus. The interventricular septum was intact and atrioventricular and ventriculoatrial concordance was preserved. Detection of a dilated coronary sinus by transthoracic 2D echocardiography must be followed by multimodal imaging techniques like cardiac computed tomography and transesophageal echocardiography to detect and manage associated defects.
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Affiliation(s)
- Gajanan Khadkikar
- Cardiology, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Subrahmanya Murti V
- Cardiology, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Aman Patel
- Cardiology, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
| | - Sanjay C Shah
- Interventional Cardiology, Apex Heart Institute, Ahmedabad, IND
| | - Tejas M Patel
- Cardiology, Smt. Nathiba Hargovandas Lakhmichand (NHL) Municipal Medical College, Ahmedabad, IND
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11
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Shi H, Yan J, Wang Q, Hua Z, Li S, Zhang J. Surgical management of unroofed coronary sinus syndrome: A 20-year-single-center experience. J Card Surg 2020; 36:589-595. [PMID: 33355957 DOI: 10.1111/jocs.15269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Unroofed coronary sinus syndrome (UCSS) is rare and often associated with the left superior vena cava (LSVC). We report our experience of the clinical features, diagnosis, associated anomalies, surgical procedures, and late outcomes of UCSS during a 20-year period. METHODS One hundred and fifty-nine patients with UCSS were treated surgically and followed up between May 1998 and May 2019. UCSS was confirmed by preoperative echocardiography or computerized tomography (CT) scan in 97 patients and by the surgeons intraoperatively in 62 cases, and 100 cases were associated with LSVC. Among these patients, eight cases underwent ligation, and the intracardiac tunnel or baffle was reconstructed in 71 cases to ensure drainage of the LSVC into the right atrium (RA), and the extracardiac procedure was to lead the LSVC into the RA in three patients. Coronary sinus opening was diverted to the RA by the atrial septal patch in three cases. Thirteen patients underwent the reroof procedures, and two patients had untreated LSVC. The associated cardiac lesions were corrected concomitantly. RESULTS There were five in-hospital deaths. Follow-up of 143 patients of early survivors was done, and no deaths were reported. No serious complications were observed, with the exception of avulsion of the internal tunnel patch in one patient. CONCLUSION UCSS is often misdiagnosed during preoperative evaluation of congenital heart diseases. Preoperative transthoracic echocardiography remains the most important method in the diagnosis of UCSS. We adopted multiple surgical approaches to manage the different types of UCSS with LSVC with good results.
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Affiliation(s)
- Hao Shi
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Jun Yan
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Qiang Wang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Zhongdong Hua
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Shoujun Li
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
| | - Jing Zhang
- Department of Pediatric Cardiac Surgery, National Center for Cardiovascular Disease and Fuwai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, P. R. China
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12
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Mishra AK, Kumar V, Maramreddy R. High origin of the right coronary artery with partial anomalous pulmonary venous connection to the left superior caval vein in tetralogy of Fallot. J Card Surg 2020; 35:3244-3247. [PMID: 32840912 DOI: 10.1111/jocs.14976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The prevalence of anomalous origin of coronary artery in tetralogy of Fallot has been reported to be around 4% to 6%. The association of high take-off of the right coronary artery from the distal part of the ascending aorta in tetralogy of Fallot in the presence of a partial anomalous pulmonary venous connection (PAPVC) to the left superior caval vein draining into the left atrium is not known to the best of our knowledge. We herein describe such a case when the anomalous right coronary artery and the PAPVC were detected incidentally during intracardiac repair; signifying the importance of a thorough assessment of the anatomy before surgery.
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Affiliation(s)
- Anand K Mishra
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Kumar
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Revanth Maramreddy
- Department of Cardiothoracic and Vascular Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Chowdhury UK, Anderson RH, George N, Singh S, Sankhyan LK, Gayatri SB, Malik V, Gharde P, Sengupta S. A Review of the Surgical Management of Anomalous Connection of the Right Superior Caval Vein to the Morphologically Left Atrium and Biatrial Drainage of Right Superior Caval Vein. World J Pediatr Congenit Heart Surg 2020; 11:466-484. [PMID: 32645787 DOI: 10.1177/2150135120912677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present perspective is a synthesis of published investigations in the setting of anomalous connection of the right superior caval vein to the morphologically left atrium or biatrial drainage of the right caval vein. We identified 57 suitable cases from 97 investigations, reviewing the clinical presentation, diagnostic modalities utilized, surgical techniques used, and their outcomes. Clinical presentation, radiographic findings, saline contrast echocardiography, computed tomographic angiocardiography, radionuclide perfusion scan, magnetic resonance imaging, and angiocardiography provided the diagnostic information and were used to define the disease entities before surgery. We have also addressed several issues concerning the influence of the so-called heterotaxy: the establishment of the diagnosis, the variation in clinical presentation, and subsequent management. For the overall group of patients undergoing either surgical intervention or transcatheter treatment with an Amplatzer vascular plug, the operative mortality remains high at 9.5%. We submit that an increased appreciation of these disease entities will contribute to improved future surgical management.
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Affiliation(s)
- Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Biosciences Institute, Newcastle University. Newcastle upon Tyne, United Kingdom
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sukhjeet Singh
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmi Kumari Sankhyan
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Sushama B Gayatri
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vishwas Malik
- Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Parag Gharde
- Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjoy Sengupta
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
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14
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Elhamamsy M, Aldemerdash A, Zahran F, Bakir BM, Alanazi NA, Awadallah YA, Haggag SI, Alshiekh MS. Persistent left superior vena cava in patient with right atrial myxoma undergoing open heart surgery. A case report and review of literature. Saudi J Anaesth 2020; 14:217-220. [PMID: 32317878 PMCID: PMC7164439 DOI: 10.4103/sja.sja_511_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 09/24/2019] [Indexed: 11/04/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a rare and asymptomatic congenital cardiovascular anomaly. Being asymptomatic, PLSVC was usually discovered while performing interventions (such as insertion of central lines, Swan-Ganz catheters, or placing pacemakers) through the left internal jugular vein or left subclavian veins. Commonly, PLSVC is detected not only as an isolated congenital anomaly, but also it can be associated with many other cardiac anomalies. Also, presence of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by contrast venography or computed tomography angiography. The present case is a female patient, 29 year old, who was undergoing elective excision of a right atrial mass, with closure of patent foramen ovale, and she had end-stage renal failure on regular hemodialysis three times weekly through a permicath inserted in the right subclavian vein.
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Affiliation(s)
- Mostafa Elhamamsy
- Department of Cardiac Anesthesia, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - A Aldemerdash
- Department of Cardiac Anesthesia, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - F Zahran
- Department of Cardiac Anesthesia, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - B M Bakir
- Department of Cardiac Surgery, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Nouf A Alanazi
- Department of Interventional Cardiology, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yasser Abdulrahman Awadallah
- Department of Cardiac Surgery, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Sami Ibrahim Haggag
- Department of Cardiac Surgery, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Mahmoud Salama Alshiekh
- Department of Cardiac Surgery, King Fahd Cardiac Center, College of Medicine, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
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15
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Litwak N, Zeppa FI, Verón LF. [Persistent left superior vena cava, absence of the right superior vena cava and tricuspid regurgitation]. Medicina (B Aires) 2020; 80:557-559. [PMID: 33048802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
The persistence of a left superior vena cava in the general population represents one of the most frequent thoracic venous return malformations, however its association with abscence of the right superior vena cava and tricuspid regurgitation are extremely rare findings.
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Affiliation(s)
- Nahuel Litwak
- Instituto de Cardiología y Cirugía Cardiovascular (ICyCC), Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina. E-mail:
| | - Federico Ignacio Zeppa
- Servicio de Ecocardiografía y Doppler Vascular, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
| | - Luis Facundo Verón
- Servicio de Resonancia Magnética Cardiovascular, Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
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Abstract
Waardenburg syndrome (WS) is a rare genetic disorder secondary to neural crest cell developmental abnormalities. It is predominantly described as an auditory–pigmentary syndrome with diverse patient presentation, typically involving congenital sensorineural hearing loss and pigmentation abnormalities of the skin, hair, and iris. Other developmental abnormalities that may be associated with this syndrome are Hirschsprung's disease and a myriad of cardiovascular congenital defects. We present a case of a young girl with WS who found to have a persistent left superior vena cava (PLSVC) draining into the coronary sinus. The prevalence of PLSVC is increased in patients with chromosomal and genetic abnormalities. However, we are the first to report its presence in association with WS while discussing the challenges that may arise during central venous catheter placement in patients with PLSVC.
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Affiliation(s)
- Driss Raissi
- Department of Radiology, University of Kentucky, Kentucky, USA
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Nakajima K, Fujisawa T, Kashimura S, Kunitomi A, Katsumata Y, Nishiyama T, Kimura T, Nishiyama N, Aizawa Y, Takatsuki S. Puncture of the Closed Coronary Sinus Ostium in a Patient With Coronary Sinus Atresia. JACC Clin Electrophysiol 2018; 3:640-642. [PMID: 29759440 DOI: 10.1016/j.jacep.2016.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/19/2016] [Accepted: 12/22/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Kazuaki Nakajima
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Shin Kashimura
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Akira Kunitomi
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Takahiko Nishiyama
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Nobuhiro Nishiyama
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Shinjukuku, Tokyo, Japan.
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Ramman TR, Dutta N, Chowdhuri KR, Agrawal S, Girotra S, Azad S, Radhakrishnan S, Iyer PU, Iyer KS. Left Superior Vena Cava Draining Into Left Atrium in Tetralogy of Fallot-Four Cases of a Rare Association. World J Pediatr Congenit Heart Surg 2018; 11:NP120-NP124. [PMID: 29506453 DOI: 10.1177/2150135117742625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persistent left superior vena cava is a common congenital anomaly of the thoracic venous system. Left superior vena cava draining into left atrium is a malformation of sinus venosus and caval system. The anomaly may be a cause of unexplained hypoxia even in adults. It may give rise to various diagnostic and technical challenges during cardiac catheterization and open-heart surgery. It is often detected serendipitously during diagnostic workup. Isolated left superior vena cava opening into left atrium is very commonly associated with other congenital heart defects. But tetralogy of Fallot is very rarely associated with persistent left superior vena cava which drains into left atrium. We report four such cases who underwent surgical correction successfully.
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Affiliation(s)
- Tarun Raina Ramman
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Nilanjan Dutta
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Kuntal Roy Chowdhuri
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Sunny Agrawal
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Sumir Girotra
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Sushil Azad
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Sitaraman Radhakrishnan
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Parvathi Unninayar Iyer
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
| | - Krishna Subramony Iyer
- Department of Pediatric and Congenital Heart Sciences, Fortis Escorts Heart Institute, New Delhi, India
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19
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Abstract
Central venous catheters are placed in approximately five million patients annually in the US. The preferred site of insertion is one with fewer risks and easier access. Although the right internal jugular vein is preferred, on occasion, the left internal jugular may have to be accessed. A patient was admitted for septic shock, cerebrovascular accident, and non-ST-segment elevation myocardial infarction. A central venous line was needed for antibiotic and vasopressor administration. Due to trauma from a fall to the right side and previously failed catheterization attempts at the left subclavian and femoral veins, the left internal jugular vein was accessed. On chest radiography for confirmation, the left internal jugular central venous catheter was seen projecting down the left paraspinal region. It did not take the expected course across the midline toward the right and into the superior vena cava (SVC). A review of a computed tomography (CT) scan of the chest with contrast done on a prior admission revealed a duplicated SVC on the left side that had not been reported in the original CT scan interpretation. A left-sided SVC is present in approximately 0.3% to 0.5% of the population, with 90% of these draining into the coronary sinus. During placements of central venous lines and pacemakers, irritation of the coronary sinus may result in hypotension, arrhythmia, myocardial ischemia, or cardiac arrest. A widened mediastinum can be an indication of a duplicated SVC. When attempting a left internal jugular vein central venous catheter placement, it is important to be aware of venous anomalies in order to prevent complications.
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Affiliation(s)
- Peter Paik
- Internal Medicine, St. Joseph Mercy Oakland Hospital
| | | | - Anupam A Sule
- Internal Medicine, St. Joseph Mercy Oakland Hospital
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20
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Abstract
Persistent left superior vena cava (PLSVC) is a rare disorder which is asymptomatic and hence is usually discovered while performing interventions through the left subclavian vein. We present a case of a 78-year-old male who was undergoing elective placement of a permanent pacemaker for tachycardia – bradycardia syndrome with post-conversion pauses of up to nine seconds. After achieving access through the left subclavian vein the wire kept on going on the left side of the chest instead of crossing the midline to the right side. The wire was removed and contrast venography was done, PLSVC with dilated coronary sinus emptying into the right atrium was confirmed. There was some difficulty in passing the lead to the right ventricle even with the acute curve in the stylet. The sheath size was increased and a longer deflectable sheath was used and with the tip of the lead anteriorly the right ventricle was cannulated and the lead was affixed. There were good sensing and pacing parameters. Post procedure chest x-ray was done and the patient was discharged without any complications.
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Affiliation(s)
- Murtaza Sundhu
- Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA
| | - Mubbasher Syed
- Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA
| | - Sajjad Gul
- Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA
| | - Bilal Saqi
- Internal Medicine Residency, Fairview Hospital, Cleveland Clinic, USA
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21
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Jazayeri MA, Karim R. What's in a Name? Utilization of the Innominate Vein for Pacemaker Lead Placement in the Setting of Persistent Left Superior Vena Cava. Cureus 2017; 9:e1057. [PMID: 28367394 PMCID: PMC5364088 DOI: 10.7759/cureus.1057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) represents the most common thoracic venous anomaly and is an important clinical entity for cardiologists and electrophysiologists, among others. In approximately 30% of cases, a bridging innominate vein connects the left superior vena cava to the right. The present report highlights the value of defining the venous anatomy with a case of dual-chamber pacemaker implantation in the PLSVC with the right ventricular lead placed via the innominate vein. Pertinent considerations for device implantation in the setting of this anomaly are discussed and relevant venography reviewed.
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Affiliation(s)
| | - Rehan Karim
- Division of Cardiology, Hennepin County Medical Center, University of Minnesota Medical School
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22
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Egbe AC, Said SM, McLeod CJ, Barbara DW, Connolly HM. An Unusual Case of Raghib Defect and Double-Orifice Tricuspid Valve. World J Pediatr Congenit Heart Surg 2016; 9:257-259. [PMID: 27881810 DOI: 10.1177/2150135116673017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Raghib defect and double-orifice tricuspid valve are two rare congenital heart defects. We report a case of a 42-year-old man with both Raghib defect and DOTV. The patient underwent reroofing of the coronary sinus with an intra-atrial baffle and annuloplasty of the tricuspid and mitral valves via median sternotomy.
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Affiliation(s)
- Alexander C Egbe
- 1 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Sameh M Said
- 2 Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - David W Barbara
- 3 Division of Cardiothoracic Anesthesia, Mayo Clinic, Rochester, MN, USA
| | - Heidi M Connolly
- 1 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
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23
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Karl K, Sinkovskaya E, Abuhamad A, Chaoui R. Intrathymic and other anomalous courses of the left brachiocephalic vein in the fetus. Ultrasound Obstet Gynecol 2016; 48:464-469. [PMID: 26499470 DOI: 10.1002/uog.15795] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 10/18/2015] [Accepted: 10/20/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The left brachiocephalic vein (LBCV), or innominate vein, connects the left jugular vein to the right superior vena cava. Its course is posterior to the thymus and directly anterior and superior to the aortic arch. Pediatric and adult cardiology studies have reported on the subaortic or retrotracheal courses of the LBCV and the presence of double LBCV. We observed recently in the fetus that the LBCV may have a course through the thymus (intrathymic) or be absent in the presence of a left superior vena cava. The aim of this study was to report the prevalence of isolated intrathymic and absent LBCV in normal fetuses undergoing second-trimester ultrasound screening, as well as the prevalence of other courses in association with cardiac anomalies. METHODS In the prospective part of this study, consecutive second-trimester ultrasound examinations were evaluated to assess the presence and course of the fetal LBCV. In the retrospective case-control part of this study, the databases of two fetal medicine centers were reviewed for cardiac anomalies and the pattern and prevalence of anomalous courses of the LBCV were reported. RESULTS One thousand four hundred and eighteen consecutive fetuses were examined prospectively. An intrathymic course of the LBCV with a typical bent shape was found in 1.76% (1 : 57) of cases and the absence of a LBCV in association with a persistent left superior vena cava (LSVC) was found in 0.28% (1 : 350). All fetuses with an isolated intrathymic course or absence of the LBCV had a normal outcome. Over a period of 4.5 years, a total of 1544 fetuses with cardiac malformations were reviewed at two centers. Among these, an anomalous course of the LBCV was noted in eight (0.5%) cases: six subaortic, one retrotracheal and one double LBCV. CONCLUSION An intrathymic LBCV is a common condition and appears to be a normal variant in the fetus. The prevalence of a LSVC in our screening population was similar to that reported in previous studies. Anomalous courses of the LBCV are seen occasionally in cases with cardiac malformation. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- K Karl
- Center for Prenatal Diagnosis, Munich, Germany.
| | - E Sinkovskaya
- Division of Maternal-Fetal Medicine of the Department of Obstetrics & Gynecology at Eastern Virginia Medical School, Norfolk, VA, USA
| | - A Abuhamad
- Division of Maternal-Fetal Medicine of the Department of Obstetrics & Gynecology at Eastern Virginia Medical School, Norfolk, VA, USA
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
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24
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Nath RK, Soni DK. Retrograde non trans-septal balloon mitral valvotomy in mitral stenosis with interrupted inferior vena cava, left superior vena cava, and hugely dilated coronary sinus. Catheter Cardiovasc Interv 2015; 86:1289-93. [PMID: 26032663 DOI: 10.1002/ccd.25973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 04/01/2015] [Accepted: 04/05/2015] [Indexed: 11/06/2022]
Abstract
A 22-year-old woman with severe mitral stenosis was referred to us for further evaluation and management. She was found to have severe mitral stenosis, severe tricuspid regurgitation with dilated right atrium and right ventricle with persistent left superior vena cava and hugely dilated coronary sinus. Valve was suitable for balloon mitral valvotomy. Cardiac catheterization showed interrupted inferior vena cava with azygos continuation to right atrium and large left superior vena cava draining to coronary sinus which was very much dilated. Right trans-jugular approach was tried for balloon mitral valvotomy, but was unsuccessful due to a very large right atrium and coronary sinus. Retrograde non trans-septal approach was used and balloon valvotomy was done successfully using a 24 mm × 40 mm TYSHAK balloon without any major complication. Reduction in the transmitral pressure gradient on cardiac catheterization data and transthoracic echocardiography confirmed successful procedure. Balloon mitral valvotomy can be done successfully in patients with the above unusual cardiac anatomy with no major procedural complications.
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Affiliation(s)
- Ranjit Kumar Nath
- Department of Cardiology, PGIMER, Dr. RML Hospital, New Delhi, India
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25
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Chu GS, Coviello I, Mollo R, Ng GA. Successful Ablation of Atrial Fibrillation by Targeting Fractionation in a Left-Sided Superior Vena Cava. J Cardiovasc Electrophysiol 2015; 26:1275-1277. [PMID: 25996465 DOI: 10.1111/jce.12716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 05/10/2015] [Accepted: 05/18/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Gavin S Chu
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, Glenfield Hospital, Leicester, UK
| | | | - Roberto Mollo
- Department of Cardiology, Glenfield Hospital, Leicester, UK
| | - G André Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,Department of Cardiology, Glenfield Hospital, Leicester, UK.,Leicester NIHR Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Leicester, UK
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26
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Kusa J, Szydlowski L, Nowakowska E, Skierska A. Recanalisation of the left superior caval vein after Fontan procedure: not so rare complication: possibilities of percutaneous closure using various devices. Cardiol Young 2015; 25:485-90. [PMID: 24702777 DOI: 10.1017/S104795111400016X] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AIM Evaluation of possibilities of percutaneous closure of recanalised left superior caval vein after total cavopulmonary connection. METHODS AND RESULTS We analysed 19 patients after total cavopulmonary connection catheterised because of a sudden increase of desaturation. In four of them, the recanalisation of the left superior caval vein was identified. For this reason, the balloon occlusion tests of the veins were made temporarily. In all cases, the haemodynamic status of patients did not change, and arterial oxygen saturation increased significantly. Thus, using different types of implants, these veins were closed effectively in all patients. During the short-term follow-up, the effectiveness of treatments and constantly maintaining a high level of saturation were confirmed. CONCLUSIONS Meticulous investigation of unclear causes of desaturation in cyanotic patients after Fontan completion is necessary. Almost all causes of desaturation, including recanalised additional left superior caval vein, can be effectively treated percutaneously.
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27
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Abstract
A 9-year-old girl with cyanosis, dyspnea, and grade II clubbing was diagnosed by contrast transthoracic echocardiography and angiocardiography to have an anomalous connection of the venae cavae to the physiologic left atrium with partial anomalous pulmonary venous connection. Successful surgical correction was achieved, and the patient's recovery was uneventful.
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Affiliation(s)
- Gopakumar Vallath
- Department of Cardiothoracic and Vascular Surgery, Sri Sathya Sai Institute of Higher Medical Sciences, Prasanthigram, India
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28
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Eldin GS, El-Segaier M, Galal MO. High prevalence rate of left superior vena cava determined by echocardiography in patients with congenital heart disease in Saudi Arabia. Libyan J Med 2013; 8:21679. [PMID: 24107708 PMCID: PMC3794077 DOI: 10.3402/ljm.v8i0.21679] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/13/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Persistent left superior vena cava (LSVC) is one of the common anomalies of the systemic veins. Its prevalence is 0.1-0.3% in the general population and is more common with congenital heart disease (CHD). The importance of detecting persistent LSVC prior to cardiac surgery is paramount for systemic veins cannulations. AIM The aim was to evaluate the prevalence of persistent LSVC in patients with CHD in Saudi Arabia. METHODS All patients referred to our institution had echocardiography. All complete studies were reviewed for the presence of persistent LSVC. A computerized database was created including the demographic data, CHD diagnoses, and the presence of persistent LSVC. RESULTS A total of 2,042 were examined with an age range of 1 day to 16 years. The complete echocardiographic studies were 1,832 (90%) of whom 738 (40%) patients had CHD. The prevalence of persistent LSVC in patients with CHD was 7.8% (OR 9.26, 95% CI 4.7-18.2, p<0.001). The most common cardiac defect associated with persistent LSVC was complete atrioventricular septal defect (AVSD); all patients with AVSD had Down syndrome. The total number of patients with AVSD was 41, and persistent LSVC was found in 11 (26%) of them (odds ratio 5.1, 95% CI 2.4-10.8, p<0.001). CONCLUSIONS The prevalence of persistent LSVC in the current population is almost double the reported prevalence obtained using the same echocardiographic screening tool.
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Affiliation(s)
- Ghada Shiekh Eldin
- Department of Paediatric Cardiology, PSHC, King Fahd Medical City, Riyadh, Saudi Arabia
| | - Milad El-Segaier
- Department of Paediatric Cardiology, PSHC, King Fahd Medical City, Riyadh, Saudi Arabia
- Department of Paediatric Cardiology, Skåne University Hospital, Lund, Sweden
| | - Mohammed Omer Galal
- Department of Paediatric Cardiology, PSHC, King Fahd Medical City, Riyadh, Saudi Arabia
- Department of Paediatric Cardiology, University of Essen, Essen, Germany
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29
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Gupta SK, Ramakrishnan S, Doshi S. Cor triatriatum: an unusual cause of elevated pulmonary capillary wedge pressure in a child with tetralogy of Fallot. Catheter Cardiovasc Interv 2013; 82:E507-10. [PMID: 23172678 DOI: 10.1002/ccd.24752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 11/07/2012] [Indexed: 11/12/2022]
Abstract
The coexistence of cor triatriatum and tetralogy of Fallot (TOF) is rare. Preoperative identification of cor triatriatum may be difficult owing to reduced pulmonary blood flow in patients with TOF. However, it is imperative to identify this rare combination as failure to identify obstruction to pulmonary venous egress may result in persistent pulmonary venous hypertension postoperatively. The authors discuss hemodynamic aspects of this rare coexistence in a 14-month-old child in whom pulmonary capillary wedge pressure was elevated despite right ventricular outflow obstruction.
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Affiliation(s)
- Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
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30
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Affiliation(s)
- Suzette S Singh
- Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY
| | - Pritul Patel
- Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY
| | - Mary Salvatore
- Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY
| | - Amanda J Rhee
- Department of Anesthesiology, The Mount Sinai Medical Center, New York, NY.
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Courand PY, Girerd N, Chauveau S, Chevalier P. Right superior vena cava drainage into the left atrium revealed by multiples strokes after pacemaker implantation. Heart Rhythm 2013; 10:1735-6. [PMID: 22863885 DOI: 10.1016/j.hrthm.2012.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Indexed: 11/21/2022]
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32
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Abstract
The coronary sinus (CS) is a small tubular structure just above the posterior left atrioventricular junction. The CS can be imaged in several different echocardiographic views. Using zoom M-mode recordings of the CS in apical two-chamber view, CS caliber can be sharply imaged and easily measured during different phases of the cardiac cycle. We have recently shown that the CS narrows during atrial contraction in persons with sinus rhythm, but does not narrow at all if atrial fibrillation is present. Attenuation of CS narrowing occurs in patients with congestive heart failure and inferior vena cava plethora. Maximal CS caliber occurs during ventricular systole. Patients with poor left ventricular systolic function show mild CS dilatation. Greater CS dilatation is present in patients with persistent left superior vena cava, and huge dilatation when this anomaly is accompanied by absence of a right superior vena cava. Injection of sonicated saline into a left and then a right arm vein is diagnostically useful in confirming these two venous anomalies. Pulsed-wave Doppler of the CS can be recorded in the parasternal right heart inflow view. From this and from the CS cross-section area it may be possible to estimate coronary blood flow.
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Affiliation(s)
- I A D'Cruz
- Department of Cardiology, VA Medical Center, Memphis, Tennessee 38104, USA
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33
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Gonzalez-Juanatey C, Testa A, Vidan J, Izquierdo R, Garcia-Castelo A, Daniel C, Armesto V. Persistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review. Clin Cardiol 2004; 27:515-8. [PMID: 15471164 PMCID: PMC6654321 DOI: 10.1002/clc.4960270909] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2003] [Accepted: 01/27/2004] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly. HYPOTHESIS This study examines the epidemiologic, clinical, and morphologic characteristics of a cohort of patients with PLSVC draining into the coronary sinus. METHODS We examined the clinical and morphologic characteristics of patients with PLSVC draining into the coronary sinus diagnosed at a single referral hospital for a defined population in northwestern Spain. We designed a prospective study of the case records of all patients diagnosed with PLSVC draining into the coronary sinus at the echocardiography laboratory of the Hospital Xeral-Calde from January 2001 through December 2002. Patients were included if they had a PLSVC diagnosed by transthoracic echocardiogram (TTE) using an echo-contrast enhancement and confirmed by a magnetic resonance (MR) imaging. Ten patients (6 women) fulfilled the inclusion criteria described above. All patients were adults and had associated heart disease, including a congenital heart disease in three cases. RESULTS Magnetic resonance imaging examination confirmed the presence of PLSVC and the site of drainage into the coronary sinus. Absence of the right superior vena cava was observed only in three patients, in whom the main coronary sinus size was significantly increased. Absence of the left brachiocephalic vein was diagnosed in five patients. CONCLUSION This study describes 10 new cases of PLSVC and supports the necessity of considering PLSVC draining into the coronary sinus in the diagnosis of patients presenting with dilated coronary sinus diagnosed by TTE. It also underlines the important role of MR imaging in the evaluation of these abnormalities. An associated heart disease must always be excluded in these patients.
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