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De Innocentiis C, Buonpane A, Totaro A, Restaino G, Astore P, Guarino M, Langella V, Gallina S, Santamaria M. It's a long way to the top! Congenital venous anomalies and left isomerism limiting atrial fibrillation transcatheter ablation. Curr Probl Cardiol 2024; 49:102467. [PMID: 38369208 DOI: 10.1016/j.cpcardiol.2024.102467] [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] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Catheter ablation is increasingly used to improve symptoms and prognosis in selected patients. Lower limb venous access with subsequent transseptal approach to the left atrium is the standard procedure for atrial fibrillation catheter ablation. CASE PRESENTATION We report an unusual case of complex venous anomaly with a left-sided inferior vena cava with hemiazygos continuation to a persistent left superior vena cava draining in an enlarged coronary sinus in a patient with persistent atrial fibrillation scheduled for transcatheter ablation. DISCUSSION Lower limb venous anomalies may limit a standard transseptal approach to the left atrium thus precluding an effective catheter ablation procedure for atrial fibrillation. Alternative interventions, such as unconventional percutaneous access, thoracoscopic approach and "ablate and pace" procedures, may be necessary in patients with symptomatic atrial fibrillation and complex venous anomalies.
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Affiliation(s)
- Carlo De Innocentiis
- Arrhythmology and Electrophysiology Unit, Responsible Research Hospital, Largo Agostino Gemelli, 1. 86100, Campobasso (CB), Campobasso, CB, Italy.
| | - Angela Buonpane
- Agostino Gemelli IRCCS University Hospital Foundation, Rome, Italy
| | - Antonio Totaro
- Interventional Cardiology Unit, Responsible Research Hospital, Campobasso, CB, Italy; Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, CB, Italy
| | - Gennaro Restaino
- Radiology Unit, Responsible Research Hospital, Campobasso, CB, Italy
| | - Pasquale Astore
- Arrhythmology and Electrophysiology Unit, Responsible Research Hospital, Largo Agostino Gemelli, 1. 86100, Campobasso (CB), Campobasso, CB, Italy
| | | | | | - Sabina Gallina
- Department of Neurosciences, Imaging and Clinical Sciences, Institute of Cardiology, Heart Department, "G. d'Annunzio" University Chieti-Pescara and University Cardiology Division, SS Annunziata University Hospital, Chieti, Italy
| | - Matteo Santamaria
- Arrhythmology and Electrophysiology Unit, Responsible Research Hospital, Largo Agostino Gemelli, 1. 86100, Campobasso (CB), Campobasso, CB, Italy
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Smolarek D, Jankowska H, Dorniak K, Hellmann M. A rare case of isolated persistent left superior vena cava diagnosed by echocardiography. J Cardiothorac Surg 2024; 19:175. [PMID: 38575998 PMCID: PMC10996098 DOI: 10.1186/s13019-024-02709-8] [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] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/29/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND The persistent left superior vena cava (PLSVC) is an infrequent vascular variant. PLSVC with absent right superior vena cava, also known as isolated PLSVC, is an exceptionally rare entity. In this case we present a patient with isolated PLSVC draining to coronary sinus, diagnosed incidentally during echocardiography. CASE PRESENTATION A 35-year-old man underwent a transthoracic echocardiography which showed an enormously dilated coronary sinus. Hand-agitated saline was injected via peripheral intravenous cannulas. The contrast appeared firstly in the coronary sinus before it opacified the right atrium. Since this was also visible by the right antecubital saline injection, it indicated an extremely rare case of PLSVC with the absence of right superior vena cava which was confirmed by cardiac magnetic resonance. CONCLUSIONS The finding of a distinctively dilated coronary sinus in echocardiography led us to further investigation using agitated saline that revealed an infrequent anomaly termed isolated PLSVC. The in-depth diagnosis of this vascular variant is crucial considering that it may lead to important clinical implications, such as difficulties with central venous access, especially in the current era of a rapid development of cardiac device therapies.
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Affiliation(s)
- Dorota Smolarek
- Department of Cardiac Diagnostics, Medical University of Gdansk, Smoluchowskiego 17, Gdansk, 80-214, Poland.
| | - Hanna Jankowska
- Department of Cardiac Diagnostics, Medical University of Gdansk, Smoluchowskiego 17, Gdansk, 80-214, Poland
| | - Karolina Dorniak
- Department of Cardiac Diagnostics, Medical University of Gdansk, Smoluchowskiego 17, Gdansk, 80-214, Poland
| | - Marcin Hellmann
- Department of Cardiac Diagnostics, Medical University of Gdansk, Smoluchowskiego 17, Gdansk, 80-214, Poland
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Rücker B, Vigneswaran TV, Zidere V, Simpson JM. Association of Prenatally Diagnosed Isolated Single Left Superior Vena Cava and Postnatal Development of Coarctation of the Aorta. Pediatr Cardiol 2024; 45:749-758. [PMID: 38381183 DOI: 10.1007/s00246-024-03407-x] [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: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 02/22/2024]
Abstract
To report the prevalence of coarctation of the aorta (CoA) in fetuses with single left superior vena cava (SL-SVC) and to evaluate changes in echocardiographic measurements. Additionally, to report the prevalence of associated malformations. Retrospective observational study of fetuses diagnosed with SL-SVC between 2012 and 2021 at a tertiary fetal cardiology unit. In fetuses without intracardiac abnormalities, Z-scores of the ventricles, great arteries, and Doppler flow patterns are reported. We identified 47 fetuses with SL-SVC of which 8/47 (17%) had abnormal intracardiac anatomy. One fetus was lost to follow-up. Of those with normal intracardiac anatomy and postnatal follow-up (38), karyotype abnormalities were confirmed in 2/38 (5%) and ECA in 8/38 (21%). 33/38 were live-born. None developed CoA postnatally. Paired analysis of Z-scores between early and late scans of 24 fetuses showed that diameters of the right heart structures and Doppler flows of tricuspid valve increased significantly during pregnancy, while the left heart structures and flow patterns did not change. The median risk of CoA did not change between the early and the late scan. We did not observe CoA in this cohort. A degree of ventricular asymmetry was present, but this was due to right heart dominance rather than hypoplasia of left heart structures. This likely reflects redistribution of blood and does not appear to confer increased risk of CoA. Predictive models of the postnatal development of CoA which set the dimensions of right and left heart structures in relation might not be applicable in this situation.
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Affiliation(s)
- Beate Rücker
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK.
| | - Trisha V Vigneswaran
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - Vita Zidere
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
| | - John M Simpson
- Department of Congenital Heart Disease, Evelina London Children's Hospital, Guy's & St Thomas' NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK
- Harris Birthright Centre, Fetal Medicine Research Institute, King's College Hospital, London, UK
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Dewaswala N, Mangeshkar S, Bhopalwala H, Gurley JC, Leventhal AR. Percutaneous Correction of a Large Left Superior Vena Cava to Left Atrium Fistula. CASE (Phila) 2024; 8:197-201. [PMID: 38524983 PMCID: PMC10954682 DOI: 10.1016/j.case.2023.12.023] [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] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
•Fistula between the PLSVC and the LA is a rare congenital condition. •Patients can present as adults with cerebrovascular accidents and dyspnea. •Percutaneous correction using a covered stent is feasible.
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Affiliation(s)
- Nakeya Dewaswala
- Division of Cardiology, University of Kentucky, Lexington, Kentucky
| | - Shaunak Mangeshkar
- Department of Internal Medicine, Jacobi Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | - Huzefa Bhopalwala
- Department of Internal Medicine, Appalachian Regional Healthcare, Whitesburg, Kentucky
| | - John C. Gurley
- Division of Cardiology, University of Kentucky, Lexington, Kentucky
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Cubberley A, Khan H, Dohadwala M. Utilizing high-density mapping for ablation of mitral annular flutter in a patient with persistent left superior vena cava. HeartRhythm Case Rep 2024; 10:198-200. [PMID: 38496746 PMCID: PMC10943546 DOI: 10.1016/j.hrcr.2023.12.006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024] Open
Affiliation(s)
- Alex Cubberley
- Baylor Scott & White, The Heart Hospital Plano, Plano, Texas
| | - Hafiza Khan
- Baylor Scott & White, The Heart Hospital Plano, Plano, Texas
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Kawakami T, Yahagi K, Horiuchi Y, Tanabe K. Pacemaker implantation in a patient with isolated persistent left superior vena cava using a delivery catheter: a case report. Eur Heart J Case Rep 2024; 8:ytae031. [PMID: 38313325 PMCID: PMC10838164 DOI: 10.1093/ehjcr/ytae031] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
Background Persistent left superior vena cava (PLSVC) with absent right superior vena cava, also termed 'isolated PLSVC', is extremely rare. Permanent pacemaker implantation in patients with isolated PLSVC is often difficult by the usual subclavian approach due to the unique anatomy. With the advent of delivery catheters in recent years, implantation using the same system has been reported. Case summary A 47-year-old woman with symptomatic sick sinus syndrome was admitted to our institution for permanent pacemaker implantation. Preprocedural cardiac multidetector computed tomography (MDCT) showed isolated PLSVC. We performed pacemaker implantation successfully via the left subclavian approach, using the C315 delivery catheter system. The leads were stable on chest radiography, and the sensing and capture thresholds were unchanged. After the procedure, we integrated the delivery catheter images with cardiac MDCT using Ziostation, and they were well matched with the fluoroscopic images. At the 1-month follow-up, the patient was free of heart failure symptoms and had decreased levels of N-terminal prohormone of brain natriuretic peptide. Discussion The C315 delivery catheter system was considered an option for permanent pacemaker implantation in patients with isolated PLSVC. When performing permanent pacemaker implantation in patients with unusual venous anatomy, integrating the delivery catheter images with cardiac MDCT allows for appropriate preoperative catheter selection.
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Affiliation(s)
- Toshinaru Kawakami
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo 101-8643, Japan
| | - Kazuyuki Yahagi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo 101-8643, Japan
| | - Yu Horiuchi
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo 101-8643, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo 101-8643, Japan
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Kahramanoglu O, Demirci O, Uygur L, Erol N, Schiattarella A, Rapisarda AMC. Persistant Left Superior Vena Cava with and Without Right Superior Vena Cava: Significance of Prenatal Diagnosis. Pediatr Cardiol 2024; 45:377-384. [PMID: 38103069 DOI: 10.1007/s00246-023-03353-0] [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: 09/15/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023]
Abstract
This study aims to define the associated anomalies with PLSVC, and to compare single PLSVC and bilateral superior vena cava in terms of accompanying anomalies and pregnancy outcomes. This was a retrospective study of the fetuses diagnosed with single and/or bilateral SVC at a tertiary fetal medicine center during 8 years. We detected 16 cases of single PLSVC and 84 cases of bilateral SVC. We found an association between the PLSVC and cardiac and extracardiac anomalies. Comparison between single PLSVC and BSVC cases revealed significant differences in the occurrence of heterotaxy and right isomerism. The study highlights the importance of prenatal diagnosis in PLSVC cases. Isolated PLSVC with situs solitus may be considered a benign finding, but larger studies are needed to understand the clinical implications of PLSVC in relation to chromosomal anomalies. Routine screening protocols should include three-vessel and trachea views to detect PLSVC.
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Affiliation(s)
- Ozge Kahramanoglu
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No: 10, Istanbul, Turkey.
| | - Oya Demirci
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No: 10, Istanbul, Turkey
| | - Lutfiye Uygur
- Department of Perinatology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Uskudar Opr. Dr. Burhanettin Ustunel Cad. No: 10, Istanbul, Turkey
| | - Nurdan Erol
- Department of Pediatric Cardiology, Zeynep Kamil Women and Children's Diseases Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Antonio Schiattarella
- Department of Women, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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Zhang Y, Zhao R. Intracavitary electrocardiogram guidance for peripherally inserted central catheter placement in a patient with persistent left superior vena cava: A case report. J Vasc Access 2024:11297298231194859. [PMID: 38166452 DOI: 10.1177/11297298231194859] [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: 01/04/2024] Open
Abstract
Intracavitary electrocardiogram (IC-ECG) guidance is widely used for peripherally inserted central catheter (PICC) placement. The P wave variation has rarely been reported in persistent left superior vena cava (PLSVC). Here, we report a PLSVC case of P wave variation in PICC placement guided by IC-ECG. In this case, the P wave variation of the PLSVC was quite different from that of the right superior vena cava (RSVC). The tip of the catheter was located at the lower segment of the left superior vena cava according to postoperative radiography examination. PICC functioned normally, and no complications occurred.
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Affiliation(s)
- Yuejiao Zhang
- Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Ruiyi Zhao
- Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
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Calafiore AM, Totaro A, Pierro A, Sacra C, Prapas S, Katsavrias K, Testa G. Interrupted inferior vena cava draining into the coronary sinus associated with circumflex artery to coronary sinus fistula. Curr Probl Cardiol 2024; 49:102200. [PMID: 37956917 DOI: 10.1016/j.cpcardiol.2023.102200] [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] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 11/21/2023]
Abstract
In an adult patient, coronary artery fistula involving the circumflex artery (CX) connected to the coronary sinus caused aneurysm of the left main and CX associated with ectasia of the intermediate branch. The patient had posterolateral infarction with severe ischemic mitral regurgitation and moderate tricuspid regurgitation. A rare venous return anomaly was also present. The inferior vena cava, which was interrupted at the level of the liver, continued with the hemiazygos to drain into a persistent left superior vena cava, which in turn drained into the coronary sinus. Surgery included CX closure and mitral and tricuspid repair. The strategy had to be adapted to the anatomy. The fistula was dissected and snared for cardioplegia delivery, and venous return was achieved by cannulation of the superior vena cava and femoral vein. The procedure was uneventful, and 4 years later the patient is asymptomatic.
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Affiliation(s)
| | - Antonio Totaro
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy.
| | - Antonio Pierro
- Department of Radiology, San Timoteo Hospital, Termoli, Italy
| | - Cosimo Sacra
- Cardiology Unit, Tirrenia Hospital, Belvedere Marittimo, Italy
| | - Sotirios Prapas
- 1st Department of Cardiac Surgery A, Henry Dunant Hospital, Athens, Greece
| | | | - Gianluca Testa
- Department of Medicine and Health Sciences "V. Tiberio", University of Molise, Campobasso, Italy
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Menè R, Sousonis V, Combes S, Maltret A, Albenque JP, Combes N. Pulsed field ablation of a persistent left superior vena cava in recurrent paroxysmal atrial fibrillation and its effect on the mitral isthmus: A case report. HeartRhythm Case Rep 2024; 10:6-10. [PMID: 38264100 PMCID: PMC10800993 DOI: 10.1016/j.hrcr.2023.10.009] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024] Open
Affiliation(s)
- Roberto Menè
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Department of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | | | - Stéphane Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
| | - Alice Maltret
- Department of Pediatric Cardiology and Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | | | - Nicolas Combes
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
- Department of Pediatric Cardiology and Congenital Heart Diseases, Marie Lannelongue Hospital, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
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Mi ZY, He G, Gao HL, Li C. Persistent left superior vena cava in right hemiarch replacement under deep hypothermic circulatory arrest: A case report. World J Clin Cases 2023; 11:7858-7864. [DOI: 10.12998/wjcc.v11.i32.7858] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC), a relatively rare thoracic vascular malformation, can inconvenience perfusionists and operators when encountered during deep hypothermic circulatory arrest (DHCA).
CASE SUMMARY Herein, we describe the case of a patient with concurrent giant aortic arch aneurysm, aortic stenosis, and PLSVC. To treat these conditions, we performed right hemiarch and aortic valve replacements under DHCA. Notably, we applied “bilateral superior vena cava retrograde cerebral perfusion (RCP)” for cerebral protection, which significantly optimized the surgical procedure and reduced the risk of postoperative complications. The patient was discharged 14 d after surgery with no complications.
CONCLUSION Surgical intervention for PLSVC under DHCA can be performed using the bilateral superior vena cava RCP approach.
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Affiliation(s)
- Ze-Yu Mi
- Department of Cardiac Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
| | - Gang He
- Department of Cardiac Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
| | - Hong-Li Gao
- Department of Ultrasound Medicine, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
| | - Chao Li
- Department of Cardiac Surgery, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China
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Núñez-Rocha RE, Gómez-Carrillo DE, Mahecha-Carvajal ME, Pérez-Ariza V, Ochoa DL, Herrera-Almario G. Incidental finding of left-sided superior vena cava: A case report and comprehensive literature review. Int J Surg Case Rep 2023; 112:108968. [PMID: 37890237 PMCID: PMC10667895 DOI: 10.1016/j.ijscr.2023.108968] [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: 09/23/2023] [Revised: 10/18/2023] [Accepted: 10/21/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Persistent left superior vena cava (PLSVC) is a rare vascular anomaly that affects systemic venous circulation. PLSVC typically is asymptomatic as the return of venous blood to the right atrium occurs through the coronary sinus. It is important to possess a comprehensive understanding of drainage as it can present challenges in catheter placement on the right side of the heart, aiming to prevent potential complications. CASE PRESENTATION A 59-year-old female patient presented at the medical service with abdominal distention. During the examination, the presence of ascites was observed. Subsequent studies revealed peritoneal carcinomatosis of unknown origin. The patient underwent staging laparoscopy with biopsy sampling. Consequently, the placement of a catheter for chemotherapy was performed. A portable chest X-ray was obtained revealing the catheter extending along the left subclavian vein and progressing through the left paramediastinal regionThe presence of persistent left superior vena cava was confirmed after reviewing prior studies. CLINICAL DISCUSSION The most common abnormality in the venous drainage system is PLSVC. Approximately 40 % of PLSVC cases have associated significant cardiovascular anomalies, with septal defects being the most common. Recognizing anomalies and anatomical variants with the involvement of a multidisciplinary team is critical to prevent vascular complications during endovascular procedures and to tailor techniques for patients in need of cardiac endovascular procedures or cardiac devices. CONCLUSION PLSVC is often asymptomatic and discovered incidentally, it is essential to have a comprehensive understanding of this anomaly and perform meticulous imaging workup to prevent potential complications.
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Affiliation(s)
| | | | | | | | - Diana Lorena Ochoa
- Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Colombia
| | - Gabriel Herrera-Almario
- School of Medicine, Universidad de los Andes, Bogotá, Colombia; Department of Surgery, Fundación Santa Fe de Bogotá, Colombia.
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Yang X, Su XH, Zeng Z, Fan Y, Wu Y, Guo LL, Xu XY. Integrated analysis of comorbidity, pregnant outcomes, and amniotic fluid cytogenetics of fetuses with persistent left superior vena cava. World J Cardiol 2023; 15:500-507. [PMID: 37900905 PMCID: PMC10600788 DOI: 10.4330/wjc.v15.i10.500] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/29/2023] [Accepted: 09/28/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC) is the most common venous system variant. The clinical characteristics and amniotic fluid cytogenetics of fetuses with PLSVC remain to be further explored. AIM To develop reliable prenatal diagnostic recommendations through integrated analysis of the clinical characteristics of fetuses with PLSVC. METHODS Cases of PLSVC diagnosed using prenatal ultrasonography between September 2019 and November 2022 were retrospectively studied. The clinical characteristics of the pregnant women, ultrasonic imaging information, gestational age at diagnosis, pregnancy outcomes, and amniocentesis results were summarized and analyzed using categorical statistics and the chi-square test or Fisher's exact test. RESULTS Of the 97 cases diagnosed by prenatal ultrasound, 49 (50.5%) had isolated PLSVC and 48 (49.5%) had other structural abnormalities. The differences in pregnancy outcomes and amniocentesis conditions between the two groups were statistically significant (P < 0.05). No significant differences were identified between the two groups in terms of advanced maternal age and gestational age (P > 0.05). According to the results of the classification statistics, the most common intracardiac abnormality was a ventricular septal defect and the most common extracardiac abnormality was a single umbilical artery. In the subgroup analysis, the concurrent combination of intra- and extracardiac structural abnormalities was a risk factor for adverse pregnancy outcomes (odds ratio > 1, P < 0.05). Additionally, all abnormal cytogenetic findings on amniocentesis were observed in the comorbidity group. One case was diagnosed with 21-trisomy and six cases was diagnosed with chromosome segment duplication. CONCLUSION Examination for other structural abnormalities is strongly recommended when PLSVC is diagnosed. Poorer pregnancy outcomes and increased amniocentesis were observed in PLSVC cases with other structural abnormalities. Amniotic fluid cytogenetics of fetuses is recommended for PLSVC with other structural abnormalities.
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Affiliation(s)
- Xin Yang
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xin-Hui Su
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Zhen Zeng
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yao Fan
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Yuan Wu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Li-Li Guo
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Xiao-Yan Xu
- Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China.
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Sayici UI, Ari ME. Persistent left superior vena cava without right superior vena cava during fetal life. Cardiol Young 2023; 33:2122-2123. [PMID: 37127650 DOI: 10.1017/s1047951123001014] [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] [Indexed: 05/03/2023]
Abstract
Enlarged coronary sinus detected during cardiac examination in the prenatal period is the first finding that raises suspicion for persistent left superior vena cava. In this report, a patient was presented who was referred with the prediagnosis of cor triatriatum sinister in the antenatal period and diagnosed with isolated persistent left superior vena cava (SVC).
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Affiliation(s)
- Ufuk Ilker Sayici
- Sami Ulus Gynecology, Pediatric Caridology Department, Child Health and Diseases Education and Research Hospital, Ulus, Turkey
| | - Mehmet Emre Ari
- Sami Ulus Gynecology, Pediatric Caridology Department, Child Health and Diseases Education and Research Hospital, Ulus, Turkey
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15
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Strojek M, Suchodolski A, Wielgus K, Głowacki J, Szulik M. Extracorporeal membrane oxygenation cannula in persistent left superior vena cava. Acta Cardiol 2023; 78:848-849. [PMID: 37318079 DOI: 10.1080/00015385.2023.2223006] [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: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Mateusz Strojek
- Student Research Group, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Alexander Suchodolski
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Karol Wielgus
- Student Research Group, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jan Głowacki
- Department of Radiology and Radiodiagnostics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- Computed Tomography Laboratory, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Mariola Szulik
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Faculty of Medical Sciences in Zabrze, Silesian Center for Heart Diseases, Medical University of Silesia, Katowice, Poland
- Department of Medical and Health Sciences, WSB University Faculty of Applied Sciences, Dąbrowa Górnicza, Poland
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Plášek J, Vrtal J, Šipula D, Grézl T, Václavík J. Slittable sheath supported right ventricular pacing lead implantation in persistent left superior vena cava with absent right superior vena cava: a case report. J Med Case Rep 2023; 17:346. [PMID: 37574534 PMCID: PMC10424350 DOI: 10.1186/s13256-023-04073-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC) is the most common variant of systemic venous drainage. In the absence of the right superior vena cava (RSVC), implantation of a right ventricular pacing lead may be challenging. Therefore specific implantation techniques and experiences in PLSVC are worth reporting. CASE PRESENTATION We present a case report of a 90-year-old Caucasian female patient with PLSVC during single chamber pacemaker implantation due to the third-degree atrioventricular block. With common implantation techniques, we did not even reach the right ventricle. Therefore slittable CPS Direct ™ Universal sheath was employed to overcome the acute angle from PLSVC to tricuspid valve and ensure more fixation stability for longer 100-cm right ventricular lead placement. CONCLUSION This case demonstrates safe implantation of 100-cm long right ventricular bipolar active fixation pacing lead using common slittable CPS Direct ™ Universal sheath after failed attempts with "C" and "J" stylet shaped electrode. This sheath provides different angle towards tricuspid valve and more fixation stability in patient with PLSVC and absent connection to right atrium.
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Affiliation(s)
- Jiří Plášek
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic.
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958, 140 21, Prague, Czech Republic.
- Centre for Research on Internal Medicine and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic.
| | - Jiří Vrtal
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - David Šipula
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - Tomáš Grézl
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
| | - Jan Václavík
- Department of Internal Medicine and Cardiology, University Hospital Ostrava, 17. Listopadu 1790/5, 708 52, Ostrava, Czech Republic
- Centre for Research on Internal Medicine and Cardiovascular Diseases, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00, Ostrava, Czech Republic
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17
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Wang X, Yang Y, Dong J, Wang X, Zheng Y, Chen J, Shen Y, Wang H. Analysis of six cancer patients with persistent left superior vena cava identified during central venous access device placement via an intracavitary electrocardiogram. J Vasc Access 2023; 24:802-808. [PMID: 34585623 DOI: 10.1177/11297298211045576] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a rare congenital anomaly. PLSVC can be associated with clinically significant atrial septal defect (ASD) or ventricular septal defect (VSD). It is usually asymptomatic and accidentally detected during invasive procedures or imaging examinations. However, whether central venous access device (CVAD) can be placed and used in patients with PLSVC is controversial. A total of six patients were diagnosed with PLSVC and confirmed by chest CT among 3391 cancer patients who underwent CVAD placement via intracavitary electrocardiogram (IC-EKG) at the Venous Access Center (VAC) from May 2019 to December 2020. The CVADs (peripherally inserted central catheter in four patients and Ports in two patients) of these six patients were left in PLSVC. We analyzed changes in the P-wave in the IC-EKG during CVAD placement and the characteristics of the body surface electrocardiogram in these patients and discussed the catheter tip position in PLSVC. All six patients showed negative P-waves in lead II via IC-EKG from the beginning of catheterization: four patients showed negative P-waves and two showed biphasic P-waves in the body surface electrocardiogram (lead III) before catheterization. CVAD function was normal and no obvious complications were observed during the treatment of these patients. The total retention time of CVADs was 1537 days. For patients with a negative P-wave in lead II via IC-EKG during catheterization, especially in those with a negative or biphasic P-wave in lead III of the body surface electrocardiogram, PLSVC should be considered. CVAD insertion in patients with type I PLSVC is safe under certain conditions, with the proper tip position in the middle to lower part of PLSVC.
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Affiliation(s)
- Xinpeng Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yong Yang
- Department of Critical Care Medicine (ICU), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jing Dong
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Xiaozheng Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yuanyuan Zheng
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jie Chen
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Yanfen Shen
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Hongzhi Wang
- Vascular Access Center (VAC), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
- Department of Critical Care Medicine (ICU), Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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18
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Arango S, Olmscheid J, Perry TE, Richardson SM. Three-Dimensional Modeling of a Pulmonary Artery Catheter in the Coronary Sinus: A Rare Case of Left Persistent Superior Vena Cava and Absence of Right Superior Vena Cava. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00242-2. [PMID: 37173170 DOI: 10.1053/j.jvca.2023.04.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/22/2023] [Accepted: 04/05/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Susana Arango
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Minnesota, Minneapolis, Minnesota.
| | - Jillian Olmscheid
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Minnesota, Minneapolis, Minnesota
| | - Tjörvi E Perry
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Minnesota, Minneapolis, Minnesota
| | - Stephen M Richardson
- Department of Anesthesiology, Division of Cardiothoracic Anesthesia, University of Minnesota, Minneapolis, Minnesota
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Uemura T, Kondo H, Shinohara T, Takahashi M, Akamine K, Ogawa N, Hirota K, Fukui A, Akioka H, Yufu K, Takahashi N. Multiple accessory pathways coexisting with a persistent left superior vena cava: a case report. J Med Case Rep 2023; 17:111. [PMID: 36967399 PMCID: PMC10041748 DOI: 10.1186/s13256-023-03865-6] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/28/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND Wolff-Parkinson-White syndrome is characterized by a short PR interval (delta-wave), long QRS complex, and the appearance of paroxysmal supraventricular tachycardia. Patients with Wolff-Parkinson-White syndrome usually have one accessory pathway, whereas cases with multiple accessory pathways are rare. Persistent left superior vena cava is a vascular anomaly in which the vein drains into the right atrium through the coronary sinus at the junction of the left internal jugular and subclavian veins due to abnormal development of the left cardinal vein. The simultaneous presence of multiple accessory pathways and persistent left superior vena cava has not been reported before. CASE PRESENTATION A 56-year-old Japanese man with a 5-year history of palpitations was referred for radiofrequency catheter ablation due to increased frequency of tachycardia episodes in the previous 2 months. Persistent left superior vena cava was confirmed by transthoracic echocardiography and computed tomography. An electrophysiological study revealed that the accessory pathways were located in the left lateral wall, anterolateral wall, and posteroseptal region. They were completely ablated with radiofrequency energy application. CONCLUSIONS We reported an extremely rare case of a patient with multiple accessory pathways and persistent left superior vena cava. Our case may suggest a potential embryological relationship between the multiple accessory pathways and persistent left superior vena cava.
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Affiliation(s)
- Tetsuya Uemura
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Masaki Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Koshiro Akamine
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Naoko Ogawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kei Hirota
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Akira Fukui
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Hidefumi Akioka
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kunio Yufu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
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20
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Liu X, Li Z, Li D, Wen H. Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia with persistent left superior vena cava: A case report. Asian J Surg 2023:S1015-9584(23)00254-3. [PMID: 36878800 DOI: 10.1016/j.asjsur.2023.02.078] [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: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Affiliation(s)
- Xiaokai Liu
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Zhuo Li
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Dongkun Li
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China
| | - Huazhi Wen
- The First Clinical Medical College of Gansu University of Chinese Medicine (Gansu Provincial Hospital), Lanzhou, China; Department of Cardiology, Gansu Provincial Hospital, Lanzhou, China.
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21
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Bonitto S, Yadav B, Vellody R, Meagher E. Catheter fragment removal from a persistent left superior vena cava in a pediatric patient. Pediatr Radiol 2023; 53:1207-1210. [PMID: 36715731 DOI: 10.1007/s00247-023-05599-5] [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: 07/18/2022] [Revised: 12/21/2022] [Accepted: 01/11/2023] [Indexed: 01/31/2023]
Abstract
Tunneled central venous catheters and ports provide a long-term method of delivering nutrition, hydration, or medications in children. When these devices are no longer needed, it is best practice to remove them entirely. Complications associated with having long-term venous access devices or the process of device removal include site infections, venous thrombosis or occlusion, device fracture, and possible migration of fractured fragments. We present a case of catheter fragmentation that occurred in a pediatric patient during removal of a 3-year-old left chest port that had been placed into a left superior vena cava (SVC).
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Affiliation(s)
- Stephano Bonitto
- The George Washington University School of Medicine and Health Sciences, Washington, D.C., USA.
| | - Bhupender Yadav
- Interventional Radiology, Children's National Medical Center, Washington, D.C., USA
| | - Ranjith Vellody
- Interventional Radiology, Children's National Medical Center, Washington, D.C., USA
| | - Elisabeth Meagher
- Interventional Radiology, Children's National Medical Center, Washington, D.C., USA
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Boukhmis A, Nouar MEA. Unusual Left Superior Vena Cava, Connected to the Left Atrium via the Left Superior Pulmonary Vein. Arch Iran Med 2022; 25:712-715. [PMID: 37542404 PMCID: PMC10685870 DOI: 10.34172/aim.2022.111] [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: 06/19/2021] [Accepted: 12/18/2021] [Indexed: 08/06/2023]
Abstract
Persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein (LSPV) is a rare systemic venous drainage anomaly. It can cause cyanosis and unexplained recurrent strokes. Undiagnosed, it can seriously disrupt the conduct of the cardiopulmonary bypass (CPB), causing sudden air lock and/or flooding of the operative field with venous blood. Its connection with the LSPV outside the pericardium makes its intraoperative diagnosis difficult. We report here the case of a 48-year-old man operated for mitral and aortic valve endocarditis, complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by the entrance of high volume of air bubbles into the superior vena cava cannula which resulted in sudden air lock of the venous outflow line. After multiple lowerings and cessations of pump flow, partial clamping of this cannula resulted in flooding of the LA with venous blood coming from the LSPV. The heart luxation did not allow us to find the LSVC in its usual intrapericardial location, between the LSPV and the left appendage. We had to widely open the left pleura to expose its completely extrapericardial path and its communication with the LSPV. The LSVC was temporally clamped during the remainder of the surgical procedure, then ligated at both ends. The patient underwent mitral valve repair, closure of the infundibular septal defect, aortic valve replacement and tricuspid annuloplasty. He was discharged 10 days later.
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Affiliation(s)
- Abdelkader Boukhmis
- Department of Cardiac Surgery, University Hospital Center MUSTAPHA, Algiers, Algeria
| | - Mohamed El-Amin Nouar
- Department of Cardiac Surgery, University Hospital Center MUSTAPHA, Algiers, Algeria
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23
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Boukhmis A, Nouar MEA. Persistent Left Superior Vena Cava, Connected to the Left Atrium via the Left Superior Pulmonary Vein. An Unusual Cause of Air Lock. J Saudi Heart Assoc 2022; 34:153-156. [PMID: 36158113 PMCID: PMC9467459 DOI: 10.37616/2212-5043.1312] [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: 07/24/2022] [Revised: 08/14/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022] Open
Abstract
The intraoperative diagnosis of a persistent left superior vena cava (LSVC) that drains into the left atrium (LA) via the left superior pulmonary vein may be difficult because of its extrapericardial pathway. We report here the case of a 48-year-old man, operated for a mitro-aortic endocarditis complicating a Laubry-Pezzi syndrome. The opening of the LA was followed immediately by a sudden air lock. It was only after opening of the left pleura that we were able to find and then ligate the LSVC. The patient underwent mitral valve repair, closure of the infundibular septal defect and aortic valve replacement.
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Zhou RN, Ma XB, Wang L, Kang HF. Accidental venous port placement via the persistent left superior vena cava: Two case reports. World J Clin Cases 2022; 10:9879-9885. [PMID: 36186175 PMCID: PMC9516935 DOI: 10.12998/wjcc.v10.i27.9879] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/27/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Breast cancer poses a great threat to females worldwide. There are various therapies available to cure this common disease, such as surgery, chemotherapy, radiotherapy, and immunotherapy. Implantable venous access ports (IVAP, referred to as PORT) have been widely used for breast cancer chemotherapy. Venous malformations are possible conditions encountered during PORT implantation. Persistent left superior vena cava (PLSVC) is a common superior vena cava malformation. Most patients have normal right superior vena cava without affecting hemodynamics, so patients often have no obvious symptoms.
CASE SUMMARY We incidentally found that two patients had PLSVC while a PORT was implanted via the internal jugular vein. Due to chemotherapy for breast cancer, PORT was successfully implanted under the guidance of ultrasound into these 2 patients. Positive chest X-ray examination after the operation showed that the catheter ran beside the left mediastinum and the end was located in the seventh thoracic vertebra. The patients had no catheter-related complications and successfully completed the course of chemotherapy. Ultrasonography found that the ratio of PORT outer diameter to PLSVC inner diameter was less than 0.45, which was in line with the recommendations of relevant literature and operating guidelines. The purpose of this article is to introduce two rare cases and review the relevant literature.
CONCLUSION Correct assessment of PLSVC status and ultrasound-guided PORT placement generally does not affect breast cancer patients chemotherapy.
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Affiliation(s)
- Rui-Na Zhou
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
| | - Xiao-Bin Ma
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
| | - Li Wang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
| | - Hua-Feng Kang
- Department of Oncology, The Second Affiliated Hospital of Xi’an Jiao Tong University, Xi'an 710004, Shaanxi Province, China
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25
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Dave V, Sesham K, Mehra S, Roy T, Ahuja M. Persistent left superior vena cava: An anatomical variation. Med J Armed Forces India 2022; 78:S277-S281. [PMID: 36147413 PMCID: PMC9485778 DOI: 10.1016/j.mjafi.2020.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/06/2019] [Accepted: 01/20/2020] [Indexed: 11/30/2022] Open
Abstract
The persistent left superior vena cava (LSVC) is a common anomaly of congenital heart disease. The presence of LSVC is commonly associated with other congenital cardiac anomalies such as atrial septal defect, tetralogy of fallot, aortic coarctation, ventricular septal defect and very rarely it occurs as an isolated finding. During a routine dissection for undergraduate students, a persistent LSVC along with variation in anterior cardiac vein and right septal pouch (RSP) was observed in heart of an approximately 48-year-old male cadaver. The persistent LSVC was draining into the right atrium via coronary sinus. The persistent LSVC is usually insignificant haemodynamically as commonly it drains into right atrium via coronary sinus, but incidental finding of LSVC is important to surgeons, interventional nephrologists and radiologists before placement of central venous access device. The insertion of central venous catheter via left internal jugular vein is difficult in presence of persistent LSVC. The right superior vena cava was normal. An anterior cardiac vein joined with the right marginal vein to form a common vein. The common vein opened into the right atrium. We also observed a RSP attached to the limbus fossa ovalis inferiorly which is a kangaroo pouch-like structure. A septal pouch is potential site predispose to thrombus formation and is more common on left side. In this case report we discuss embryology, clinical significance and review of literature related to persistent LSVC, anterior cardiac vein and SP.
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Affiliation(s)
- Vandana Dave
- PhD Scholar (Anatomy), Mahatma Gandhi Medical College, MGUMST, Jaipur, India
| | - Kishore Sesham
- Senior Resident (Anatomy), All India Institute of Medical Sciences, New Delhi, India
| | - Simmi Mehra
- Professor (Anatomy), Dr D Y Patil Medical College, Mumbai, India
| | - T.S. Roy
- Professor & Head (Anatomy), All India Institute of Medical Sciences, New Delhi, India
| | - M.S. Ahuja
- Professor, Department of Anatomy, Armed Forces Medical College, Pune, 411040, India
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26
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Abstract
ObjectiveTo investigate fetal anomalies and pregnancy outcomes in pregnancies with persistent left superior vena cava (PLSVC) to provide assistance in prenatal counseling.MethodsCases diagnosed with PLSVC between January 2015 and January 2020 were obtained from the hospital's electronic system and were analyzed retrospectively.ResultsTwenty-seven cases were analyzed. The prevalence of PLSVC among congenital heart diseases (CHD) was 6.9%. Conotruncal anomalies and renal anomalies were the most common accompanying cardiac and extracardiac anomalies, respectively. Chromosomal abnormality was detected in one fetus.In the postpartum period coarctation of aorta (CoA) was found in one fetus.ConclusionsWhen PLSVC is detected during prenatal ultrasonography, fetal anatomy should be carefully examined because of the anomalies that may accompany it. Prenatal genetic counseling should be given especially to cases with additional anomalies. In isolated cases, cardiac anatomy should be evaluated with repeated echocardiography because of the risk of CoA.
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Affiliation(s)
- Ayşe Keleş
- Perinatology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Osman Yılmaz
- Pediatric Cardiology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Gülşah Dağdeviren
- Perinatology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Özge Yücel Çelik
- Perinatology Department, University of Health Sciences Etlik Zübeyde Hanım Women's Health Care, Training and Research Hospital, Ankara, Turkey
| | - Aykan Yücel
- Perinatology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
| | - Dilek Şahin
- Perinatology Department, Ministry of Health Ankara City Hospital, Ankara, Turkey
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Kuridze N, Etsadashvili K, Minadze E, Rukhadze B, Bakashvili N, Tsverava M. Technical difficulties during electronic cardiac device implantation in patients with persistent left superior vena cava. Heliyon 2022; 8:e09801. [PMID: 35785224 PMCID: PMC9244756 DOI: 10.1016/j.heliyon.2022.e09801] [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: 02/02/2022] [Revised: 05/26/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
We report a case of persistent left superior vena cava (PLSVC), discovered by chance during the cardiac electronic device placement procedure. PLSVCs are congenital anomalies of the thoracic vasculature, during which remnants of the left superior vena cava drain into the right atrium through the coronary sinus. PLSVCs can vary in their location and overall anatomy. In patients with PLSVC, implantation of a cardiac electronic device is associated with an increased risk of technical difficulties the entire procedure.
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Affiliation(s)
- Nika Kuridze
- Faculty of Clinical and Translational Medicine, Ivane Javakhishvili Tbilisi State University, Georgia.,Rhythmology Department, G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
| | | | - Eteri Minadze
- Outpatient Department, G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
| | - Beka Rukhadze
- Rhythmology Department, G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
| | - Nana Bakashvili
- Rhythmology Department, G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
| | - Mikheil Tsverava
- Faculty of Clinical and Translational Medicine, Ivane Javakhishvili Tbilisi State University, Georgia.,Outpatient Department, G. Chapidze Emergency Cardiology Center, Tbilisi, Georgia
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Cao Q, Zhen L, Pan M, Han J, Yang X, Xu LL, Li DZ. Prenatal persistent left superior vena cava in low population: Not a benign vascular anomaly. Taiwan J Obstet Gynecol 2022; 61:459-63. [PMID: 35595438 DOI: 10.1016/j.tjog.2022.03.011] [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] [Subscribe] [Scholar Register] [Accepted: 03/16/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The aim of this study is to identify prenatally diagnosed cases of persistent left superior vena cava (PLSVC) in our clinic, to evaluate the associated structural and chromosomal results, and to review their outcome. MATERIALS AND METHODS During a four-year period, patients with fetal PLSVC were detected by echocardiography. We reviewed medical records of these affected pregnancies, including maternal demographics, sonographic findings, chromosomal microarray results and pregnancy outcomes. RESULTS There were a total of 140 cases of fetal PLSVC. Eighty-nine fetuses (63.6%) had associated structural anomalies, while the remaining 51 fetuses (36.3%) had PLSVC as an isolated finding. In the non-isolated cases, cardiac anomalies were present in 72 fetuses (80.9%), and extracardiac abnormalities in 45 fetuses (50.6%). Among the 89 cases with non-isolated PLSVC, 12 cases had chromosomal abnormalities including 5 cases of aneuploidies. Among the 51 cases with isolated PLSVC, one pregnancy of chromosomal microduplication was detected. CONCLUSION Isolated PLSVC is a benign vascular anomaly in low risk population. However, the information about background risk of identifying an abnormal clinically significant CMA result should be conveyed to all pregnant women when they consults this vascular variation.
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Akhtar Z, Sohal M, Kontogiannis C, Harding I, Zuberi Z, Bajpai A, Norman M, Pearse S, Beeton I, Gallagher MM. Anatomical variations in Coronary Venous Drainage: Challenges and Solutions in Delivering Cardiac Resynchronisation Therapy. J Cardiovasc Electrophysiol 2022; 33:1262-1271. [PMID: 35524414 DOI: 10.1111/jce.15524] [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: 02/21/2022] [Revised: 04/20/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022]
Abstract
AIMS To investigate the abnormalities of the coronary venous system in candidates for cardiac resynchronization therapy (CRT) and describe methods for circumventing the resulting difficulties. METHODS From 4 implanting institutes, data of all CRT implants between October 2008-October 2020 were screened for abnormal cardiac venous anatomy, defined as an anatomical variation not conforming to the accepted 'normal' anatomy. Patient demographics, procedural detail and subsequent left ventricle (LV) lead pacing indices were collected. RESULTS From a total of 3548 CRT implants, 15 (0.42%) patients (80% male) of 72.2±10.6 years in age with a LV ejection fraction of 34±10.3% were identified to have had an abnormal cardiac venous anatomy over the study period. There were 13 cases of persistent left side superior vena cava (pLSVC), 5 of which had coronary sinus ostium atresia (CSOA) including 2 with an 'unroofed' coronary sinus (CS); 1 patient had a unique anomalous origin of the CS and 1 patient had an isolated CSOA. In total 14 patients (60% repeat attempt) had successful percutaneous implant under general anaesthesia (46.7%) via the cephalic vein (59.1%), using the femoral approach (53.3%) for levophase venography and/or pull-through, including 1 case of endocardial LV implant. Pacing follow-up over 37.64±37.6 months demonstrated LV lead threshold between 0.62-2.9 volts (pulsewidth 0.4-1.5 milliseconds) in all cases; 5 patients died within 2.92±1.6 years of successful implant. CONCLUSION CRT devices can be implanted percutaneously even in the presence of substantial abnormalities of coronary venous anatomy. Alternative routes of venous access may be required. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zaki Akhtar
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Manav Sohal
- Department of Cardiology, St George's University Hospital, London, UK
| | | | - Idris Harding
- Department of Cardiology, St George's University Hospital, London, UK
| | - Zia Zuberi
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Royal Surrey County Hospital, Guildford, UK
| | - Abhay Bajpai
- Department of Cardiology, St George's University Hospital, London, UK
| | - Mark Norman
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Frimley Park Hospital, Surrey, UK
| | - Simon Pearse
- Department of Cardiology, St George's University Hospital, London, UK
| | - Ian Beeton
- Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
| | - Mark M Gallagher
- Department of Cardiology, St George's University Hospital, London, UK.,Department of Cardiology, Ashford and St Peter's Hospital, Surrey, UK
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Fujito T, Nagahara D, Tsuzuki T, Kamiyama N, Mochizuki A, Miura T. High defibrillation threshold with right-sided ICD implantation was resolved by a dual coil lead via persistent left superior vena cava. J Cardiol Cases 2022; 25:262-265. [PMID: 35582083 PMCID: PMC9091524 DOI: 10.1016/j.jccase.2021.10.012] [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: 06/01/2021] [Revised: 09/30/2021] [Accepted: 10/27/2021] [Indexed: 10/19/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) can be problematic when device implantation is scheduled from the left side because of the technical difficulty in delivering leads. Right-sided implantation is an alternative method, but there is a risk of a high defibrillation threshold (DFT). Transvenous implantation of an implantable cardioverter defibrillator (ICD) was scheduled for a 54-year-old man with idiopathic dilated cardiomyopathy and monomorphic non-sustained ventricular tachycardia, but computed tomography revealed the presence of a PLSVC. Right-sided ICD implantation was performed first; however, an ICD shock at 35 J failed to terminate the induced ventricular fibrillation (VF). Re-implantation via the PLSVC by a left subclavian approach with a dual coil lead was performed next. The dual coil right ventricular lead was successfully implanted via the PLSVC, and the induced VF was terminated by a single shock at 25 J. In the present case, the proximal coil was located in the coronary sinus (CS) and it enabled an antero-posterior defibrillation vector across the left ventricle. In addition to the re-location of the ICD generator from the right side to the left side, the new positioning of the proximal coil inside the CS is likely to have contributed to the great improvement of the DFT. .
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Affiliation(s)
- Takefumi Fujito
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daigo Nagahara
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Taro Tsuzuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoyuki Kamiyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Mochizuki
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
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Chen JL, Yu CG, Wang DJ, Chen HB. Misdiagnosis of unroofed coronary sinus syndrome as an ostium primum atrial septal defect by echocardiography: A case report. World J Clin Cases 2022; 10:1592-1597. [PMID: 35211597 PMCID: PMC8855266 DOI: 10.12998/wjcc.v10.i5.1592] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/24/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unroofed coronary sinus syndrome (UCSS) is a rare congenital heart disease, which has variable morphologic features and is strongly associated with persistent left superior vena cava (PLSVC). However, it is often difficult to visualize the left-to-right shunt pathway through the CS by transthoracic echocardiography (TTE).
CASE SUMMARY A 37-year-old female was admitted to the hepatological surgery department of a hospital with complaint of subxiphoid pain that had started 1 wk prior. Physical examination revealed a grade 3/6 systolic murmur at the left margin of the sternum, between the 2nd and 3rd intercostal cartilage. The patient underwent echocardiography and was diagnosed with ostium primum atrial septal defect (ASD); thus, she was subsequently transferred to the cardiovascular surgery department. A second TTE evaluation before surgery showed type IV UCSS with secundum ASD. Right-heart contrast echocardiography (RHCE) showed that the right atrium and right ventricle were immediately filled with microbubbles, but no microbubble was observed in the CS. Meanwhile, negative filling was observed at the right atrium orifice of the CS and right atrium side of the secundum atrial septal. RHCE identified UCSS combined with secundum ASD but without PLSVC in this patient.
CONCLUSION This rare case of UCSS highlights the value of TTE combined with RHCE in confirming UCSS with ASD or PLSVC.
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Affiliation(s)
- Jin-Ling Chen
- Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Cai-Gui Yu
- Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Dai-Jiao Wang
- Department of Echocardiography, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
| | - Hong-Bin Chen
- Department of Pulmonary and Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
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Kantenwein V, Telishevska M, Bourier F, Kottmaier M, Brkic A, Risse E, Popa M, Lengauer S, Kolb C, Deisenhofer I, Hessling G, Reents T. Feasibility and safety of left atrial access for ablation of atrial fibrillation in patients with persistent left superior vena cava. Pacing Clin Electrophysiol 2022; 45:357-364. [PMID: 35015906 DOI: 10.1111/pace.14446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 06/16/2021] [Revised: 12/02/2021] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with persistent left superior vena cava (PLSVC) ablation procedures can be challenging. We sought to determine the feasibility and safety of left atrial ablations in patients with PLSVC, especially when PLSVC is unknown prior to the ablation procedure. METHODS AND RESULTS In this retrospective analysis 15 adult patients (mean age 64.6 ± 14.5 years, 53.3% male) with PLSVC undergoing 27 ablation procedures for atrial fibrillation or left atrial flutter were included. In 5 (33,3%) patients PLSVC was only discovered during the procedure. Transseptal puncture (TSP) was declared "difficult" by the ablating physician in 13 of 27 (48,2%) procedures and was not successfully completed in the first attempt in two patients with known PLSVC. Once TSP was successfully completed, all relevant structures were reached both during mapping and ablation in all procedures independent of whether PLSVC was known prior to the procedure. One major complication (3,7%) occurred in 27 procedures in a patient with known PLSVC. In the patients with unknown PLSVC no complication occurred. CONCLUSION In experienced hands, left atrial access and ablation in patients with PLSVC is feasible and safe, particularly with regard to patients in whom the PLSVC is unknown prior to the ablation procedure. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Verena Kantenwein
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Marta Telishevska
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Felix Bourier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Marc Kottmaier
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Amir Brkic
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Elena Risse
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Miruna Popa
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Sarah Lengauer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Christof Kolb
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Isabel Deisenhofer
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Gabriele Hessling
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
| | - Tilko Reents
- Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung Elektrophysiologie, Technische Universität München, Munich, Germany
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Bianchi G, Concistrè G, Haxhiademi D, Caliani B, Guarino M, Solinas M. Endoscopic Mitral Valve Repair in a Patient With Persistent Left Superior Vena Cava Draining Into the Coronary Sinus - Cannulation Technique and Surgical Management. Heart Lung Circ 2021; 31:e41-e44. [PMID: 34887182 DOI: 10.1016/j.hlc.2021.11.004] [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] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 11/14/2021] [Indexed: 11/18/2022]
Abstract
Persistence of the left superior vena cava is often an incidental finding during cardiac surgical procedures. In minimally invasive valvular surgery, it may jeopardise venous drainage and myocardial protection. This How-To-Do-It paper describes the cannulation strategy in a case of minimally invasive mitral surgery in a patient with persistence of the left superior vena cava and absence of the anonymous vein detected with preoperative multimodality imaging.
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Affiliation(s)
- Giacomo Bianchi
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", Massa, Italy.
| | - Giovanni Concistrè
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Dorela Haxhiademi
- Department of Anesthesiology and Critical Cardiac Care, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Beatrice Caliani
- Unit of Clinical Perfusion, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Michele Guarino
- Unit of Clinical Perfusion, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", Massa, Italy
| | - Marco Solinas
- Department of Adult Cardiac Surgery, Ospedale del Cuore, Fondazione Toscana "G. Monasterio", Massa, Italy
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Turan OE, Yilancioglu RY, Baskurt AA, Ozcan EE. An unusual 'bow tie' image in pacemaker implantation. Indian Pacing Electrophysiol J 2021; 22:51-53. [PMID: 34737013 PMCID: PMC8811277 DOI: 10.1016/j.ipej.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 07/04/2021] [Revised: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/27/2022] Open
Abstract
Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.
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Affiliation(s)
- Oguzhan Ekrem Turan
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey.
| | | | - Ahmet Anil Baskurt
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey
| | - Emin Evren Ozcan
- Dokuz Eylul University, Faculty of Medicine, Heart Rhythm Management Center, Izmir, Turkey
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van Schuppen J, van der Hulst AE, Kuipers IM, Straver B, Boekholdt SM, Planken RN, Oostra RJ. Midline crossing pulmonary vein: right upper lobe dual venous drainage, with partial anomalous venous return of the right lung into a persistent left superior vena cava. Surg Radiol Anat 2021; 44:99-103. [PMID: 34709422 PMCID: PMC8758614 DOI: 10.1007/s00276-021-02849-9] [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: 06/14/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
Introduction We present a case of dual drainage of the right upper lobe of the lung into the left atrium and via partial anomalous venous pulmonary return (PAPVR) into a persistent left superior vena cava (SVC). Discussion It is only in the minority of PAPVR cases where the anomalous pulmonary veins cross the midline. We provide a review of current literature on this topic and an explanatory embryological model. Knowledge of embryonic development and possible anatomic variations, including the concept of dual venous drainage of the lung, leads to better interpretation of imaging, with more accurate description of the morphology at hand. High-resolution multidetector computed tomography (MDCT) helps to delineate the exact vascular anatomy. This will enhance a better understanding of and anticipation on the patient’s disease status, with more accurate planning of intervention, and possibly less complications.
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Affiliation(s)
- J van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Suite C1-234, 1105 AZ, Amsterdam, The Netherlands.
| | - A E van der Hulst
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - I M Kuipers
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - B Straver
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - S M Boekholdt
- Department of Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Suite C1-234, 1105 AZ, Amsterdam, The Netherlands
| | - R J Oostra
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
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Verma M, Pandey NN, Ojha V, Kumar S. Persistent left superior vena cava with absent right superior vena cava in the setting of viscero-atrial situs solitus: a rare systemic venous drainage. Acta Cardiol 2021; 76:918-919. [PMID: 32705930 DOI: 10.1080/00015385.2020.1796033] [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] [Indexed: 10/23/2022]
Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology & Endovascular Interventions, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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Chen Q, Hu YL, Li YX, Huang X. Peripherally inserted central catheter placement in neonates with persistent left superior vena cava: Report of eight cases. World J Clin Cases 2021; 9:7944-7953. [PMID: 34621850 PMCID: PMC8462248 DOI: 10.12998/wjcc.v9.i26.7944] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/01/2021] [Accepted: 07/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Reports on peripherally inserted central catheter (PICC) placement in neonates with persistent left superior vena cava (PLSVC) are rare. The majority of PLSVC patients have no clinical symptoms or hemodynamic changes, which are usually detected during cardiac catheterization, cardiac pacemaker implantation, or PICC placement. However, in neonates with PLSVC, PICC placement can be challenging. Here, we report PICC placement in eight neonates with PLSVC.
CASE SUMMARY This article introduces the concept of the “TIMB” bundle. After PICC implantation, we found PLSVC in all eight patients. The key points of care regarding PICC placement in neonates with PLSVC included “TIMB”, where “T” indicates a reasonable choice of the catheterization time, “I” refers to a retrospective analysis of imaging data before catheterization, “M” refers to correct measurement of the body surface length, and “B” indicates that the tip of the PICC is placed in the middle and lower 1/3 of the left superior vena cava under the guidance of B-ultrasound.
CONCLUSION “TIMB” is a bundle for PICC placement in neonates, especially for those with PLSVC. Using this new approach can improve the first-attempt success rate of PICC placement, reveal cardiovascular abnormalities in advance, allow the selection of different measurement methods reasonably according to the puncture site, and finally, improve the accuracy of catheter positioning through the use of B-ultrasound guidance.
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Affiliation(s)
- Qiong Chen
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Yan-Ling Hu
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Ying-Xin Li
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Xi Huang
- Department of Neonatal Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, Sichuan Province, China
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Ali S, Mohammed A, Co M, Kotak K, Mandapati R, Contractor T. Transfemoral snare-assisted placement of a left-sided defibrillator lead in the presence of a persistent left superior vena cava. HeartRhythm Case Rep 2021; 7:558-61. [PMID: 34434708 DOI: 10.1016/j.hrcr.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Miyazawa H, Morishima I, Kanzaki Y, Kamiya Y. Cryoablation for atrioventricular nodal re-entrant tachycardia associated with persistent left superior vena cava. Indian Pacing Electrophysiol J 2021; 21:421-424. [PMID: 34400322 PMCID: PMC8577138 DOI: 10.1016/j.ipej.2021.08.002] [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] [Received: 06/04/2021] [Revised: 07/17/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022] Open
Abstract
Catheter ablation for atrioventricular nodal re-entrant tachycardia (AVNRT) in patients with persistent left superior vena cava (PLSVC) is challenging because of anatomical abnormalities of Koch's triangle associated with the enlarged coronary sinus ostium. We present the Case of successful ablation in a patient with PLSVC using the cryoablation technique. The ablation was successfully performed without damaging the conduction system by virtue of “cryomapping” and “cryoadhesion.” Cryoablation is a safe and efficacious alternative to radiofrequency catheter ablation for the treatment of AVNRT associated with PLSVC. Catheter ablation for AVNRT in patients with PLSVC is challenging We performed successful ablation in a PLSVC patient with the cryoablation technique Ablation was successfully performed without damaging the conduction system
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Affiliation(s)
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan.
| | - Yasunori Kanzaki
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yoshihiko Kamiya
- Department of ECG Laboratory, Ogaki Municipal Hospital, Ogaki, Japan
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Kumar B, Kodliwadmath A, Upadhyay AN, Singh A, Darbari A, Nanda N. Cor triatriatum with supramitral ring: "cor tetratriatum", associated with Raghib syndrome with Eisenmenger syndrome: multimodality imaging approach in this exceedingly rare case report. Egypt Heart J 2021; 73:66. [PMID: 34273027 PMCID: PMC8286211 DOI: 10.1186/s43044-021-00183-4] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background Cor triatriatum and supramitral ring are congenital anomalies which result in formation of three chambers of atria. To the best of our knowledge, simultaneous presence of both entities in the same patient resulting in the formation of four chambers of atria has not been described in the literature. Here, we report a case of simultaneous presence of cor triatriatum and supramitral ring associated with Raghib syndrome and Eisenmenger syndrome. Case presentation We report the case of a middle-aged gentleman, who presented to us with features of atrial septal defect with Eisenmenger syndrome. Multimodality imaging confirmed the simultaneous presence of supramital ring and cor triatriatum resulting in “cor tetratriatum” along with Raghib syndrome. Presence of Eisenmenger syndrome compelled us to offer medical therapy for the patient. Conclusion This is the first case report describing the simultaneous presence of supramitral ring and cor triatriatum resulting in a new entity—“cor tetratriatum”. Supplementary Information The online version contains supplementary material available at 10.1186/s43044-021-00183-4.
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Affiliation(s)
- Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Virbhadra road, Rishikesh, Uttarakhand, 249203, India.,Department of Cardiology, PGIMER, Dr Ram Manohar Lohia Hospital, Delhi, India
| | - Ashwin Kodliwadmath
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Virbhadra road, Rishikesh, Uttarakhand, 249203, India.
| | | | - Anupam Singh
- Department of Ophthalmology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Anshuman Darbari
- Department of CTVS, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - N Nanda
- Department of Endocrinology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Mikami T. Permanent pacemaker implantation in a patient with persistent left superior vena cava with an absent right superior vena cava: A case report. J Cardiol Cases 2021; 24:34-36. [PMID: 34257759 DOI: 10.1016/j.jccase.2020.11.024] [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: 09/09/2020] [Revised: 10/29/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a common congenital anomaly of the thoracic venous system. PLSVC affects 0.3-0.5% of the general population, with 0.09-0.13% having PLSVC with an absent right superior vena cava. A 92-year-old woman was transported to our hospital by ambulance because of syncopal attacks lasting a few seconds. Electrocardiography showed paroxysmal supraventricular tachycardia and sinus arrest for up to 10 s with syncope when the arrhythmia stopped. This occurred repeatedly, and a diagnosis of sick sinus syndrome was made. The patient was scheduled for dual-chamber permanent pacemaker implantation. She had isolated PLSVC, and pacing lead was inserted into the right atrium through the PLSVC from her left subclavian vein. The "J" pre-shaped stylet was used to introduce the lead via the tricuspid valve to the right ventricular outflow tract (RVOT) and placed in the septum of RVOT. Another lead was advanced into the right atrial appendage using the "J" pre-shaped stylet. After three years of implantation, fluoroscopy showed a stable position of pacing leads, and pacemaker interrogations showed no major changes in parameters. <Learning objective: Persistent left superior vena cava (PLSVC) is a common anomaly of the thoracic venous system. PLSVC is either isolated or associated with an absent right superior vena cava and a connection with the left atrium creating a shunt. In isolated PLSVC and PLSVC with an absent right superior vena cava, implantation of a permanent pacemaker is difficult but possible using conventional devices.>.
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Affiliation(s)
- Takeshi Mikami
- Saga-ken Medical Center Koseikan, 400 Nakahara Kase-matchi, Saga-shi, Saga-ken 840-8571, Japan
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Affiliation(s)
- Sander Trenson
- University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Michael Doering
- Department of Electrophysiology, HELIOS Heart Center - University of Leipzig, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, HELIOS Heart Center - University of Leipzig, Leipzig, Germany
| | - Stephan Winnik
- University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
- Department of Electrophysiology, HELIOS Heart Center - University of Leipzig, Leipzig, Germany
- Address reprint requests and correspondence: Dr Stephan Winnik, Department of Cardiology, University Heart Center Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
| | - Sergio Richter
- Department of Electrophysiology, HELIOS Heart Center - University of Leipzig, Leipzig, Germany
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Lai ST, Chen CP, Lin CJ, Chen SW, Town DD, Wang W. Prenatal diagnosis of persistent left superior vena cava, polyhydramnios and a small gastric bubble in a fetus with VACTERL association. Taiwan J Obstet Gynecol 2021; 60:355-358. [PMID: 33678342 DOI: 10.1016/j.tjog.2021.01.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We reported a fetus that presenting with persistent left superior vena cava (PLSVC), polyhydramnios, and a small gastric bubble during prenatal examination and identified VACTERL association after birth. CASE REPORT A 34-year-old woman underwent amniocentesis at 18 weeks of gestation because of advanced maternal age and the result was normal. Subsequently, an ultrasound revealed single umbilical artery (SUA) at 21 weeks of gestation. She received a detailed fetal anatomy survey that presented the same findings and PLSVC. A small visible gastric bubble was noted at that time, and the other organs were unremarkable. Polyhydramnios was identified at 30 weeks of gestation and amnioreduction was subsequently performed at 32 weeks of gestation. However, polyhydramnios was persisted despite amnioreduction and intrauterine growth restriction was also detected. A cesarean section was performed because of fetal distress at 36 + 2 weeks, and a 1832-g female baby was delivered. Pre-axial polydactyly at left thumb, SUA and esophageal atresia with distal tracheoesophageal fistula (TEF) were identified after birth. The neonate died at age of 4 days because of surgical complication following esophageal anastomosis. CONCLUSION Prenatal diagnosis of PLSVC associated with polyhydramnios and a small gastric bubble may indicate esophageal atresia with TEF, and further examination for associated syndromes such as VACTERL association is warranted.
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Affiliation(s)
- Shih-Ting Lai
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan; Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| | - Chen-Ju Lin
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shin-Wen Chen
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Dai-Dyi Town
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wayseen Wang
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan; Department of Bioengineering, Tatung University, Taipei, Taiwan
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Shutoh F, Masuda T, Sasaki T, Takei Y. Anomalous atrium associated with persistent left superior vena cava. Anat Sci Int 2021; 96:572-576. [PMID: 33486696 DOI: 10.1007/s12565-021-00604-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
Persistent left superior vena cava (PLSVC) is the most common venous anomaly with an incidence of 0.3-0.5% in the general population. Here, we report a rare case of PLSVC with anomalous atrium in a cadaver during the student's dissection session at the University of Tsukuba. In this case, the coronary sinus had merged with the right atrium to form an enlarged sac-like structure and received systemic venous flow including inflow from the PLSVC. The roof of the coronary sinus with the right atrium was thicker than that of the control cases. We further found that the distance between the sinoatrial node and the opening of the coronary sinus was slightly more than half of that in control cases. This variant appears interesting and is worth reporting for developmental and clinical consideration.
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Affiliation(s)
- Fumihiro Shutoh
- Department of Anatomy and Neuroscience, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8577, Japan
| | - Tomoyuki Masuda
- Department of Neurobiology, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8577, Japan. .,Department of Neurology, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575, Japan.
| | - Tetsuya Sasaki
- Department of Anatomy and Neuroscience, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8577, Japan
| | - Yosuke Takei
- Department of Anatomy and Neuroscience, Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8577, Japan.
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Azizova A, Onder O, Arslan S, Ardali S, Hazirolan T. Persistent left superior vena cava: clinical importance and differential diagnoses. Insights Imaging 2020; 11:110. [PMID: 33057803 PMCID: PMC7561662 DOI: 10.1186/s13244-020-00906-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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] [Received: 05/15/2020] [Accepted: 08/20/2020] [Indexed: 01/07/2023] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and may be a component of the complex cardiac pathologies. While it is often asymptomatic, it can lead to significant problems such as arrhythmias and cyanosis. Besides, it can cause serious complications during vascular interventional procedures or the surgical treatment of cardiac anomalies (CA). The clinical significance of PLSVC depends on the drainage site and the accompanying CA. In this article, we will describe the epidemiology, embryology, and anatomic variations of PLSVC. Possible accompanying CA and heterotaxy spectrum will be reviewed with the help of multidetector computed tomography (MDCT) images. Radiological pitfalls, differential diagnoses, and the clinical importance of PLSVC will be highlighted.
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Affiliation(s)
- Aynur Azizova
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Omer Onder
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Sevtap Arslan
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Selin Ardali
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
| | - Tuncay Hazirolan
- grid.14442.370000 0001 2342 7339Department of Radiology, Hacettepe University School of Medicine, 06100 Ankara, Turkey
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Koda Y, Nishida H, Jeevanandam V, Ota T. Orthotopic heart transplantation with persistent left superior vena cava draining into coronary sinus: the anterior rerouting technique. Gen Thorac Cardiovasc Surg 2020; 69:673-678. [PMID: 33040256 DOI: 10.1007/s11748-020-01505-0] [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: 07/29/2020] [Accepted: 09/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We present a surgical technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus with orthotopic heart transplantation. METHODS Between January 2013 and July 2019, a total of 224 patients underwent orthotopic heart transplantation in our institution. Among them, three patients (3/224, 1.3%) had a persistent left superior vena cava draining into the coronary sinus. The persistent left superior vena cava and the coronary sinus was isolated and fully mobilized as an en bloc conduit at the time of explanting the heart. After the standard anastomoses using the bicaval technique, the conduit was routed anterior to the great vessels and anastomosed to the right atrial appendage. A smooth venous drainage into the right atrium from the rerouted persistent left superior vena cava was intraoperatively confirmed by transesophageal echocardiography. RESULTS The postoperative course was uneventful in all patients. There were no major postoperative complication and in-hospital mortality. The routed persistent left superior vena cava-coronary sinus conduits were confirmed to be patent without stenosis/obstruction by an enhanced computed tomography. Cardiac biopsies through the reconstructed persistent left superior vena cava were possible without any difficulty. CONCLUSION The anterior rerouting technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus in an orthotopic heart transplantation was feasible and reproducible.
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Affiliation(s)
- Yojiro Koda
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Hidefumi Nishida
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Valluvan Jeevanandam
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA
| | - Takeyoshi Ota
- Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA.
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Lewis SB, Johnson GE, Valji K, Monroe EJ, Ingraham CR, Chick JFB, Shin DS. Transjugular intrahepatic portosystemic shunt creation via isolated persistent left superior vena cava: a case series. CVIR Endovasc 2020; 3:75. [PMID: 33025347 PMCID: PMC7538481 DOI: 10.1186/s42155-020-00169-4] [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] [Received: 08/27/2020] [Accepted: 09/29/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Isolated persistent left superior vena cava (PLSVC) is a rare vascular anatomic variant, which can be an incidental finding at the time of an endovascular procedure. CASE PRESENTATION This report describes the technical success, adverse events, and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) creation via isolated PLSVC. Three adult patients with cirrhosis and isolated PLSVC underwent TIPS placement successfully with one major adverse event. Two patients required TIPS revision within 90 days. There were no deaths within 90 days. CONCLUSIONS TIPS creation via isolated PLSVC is feasible using standard techniques with a left jugular vein approach. Caution is warranted during the procedure to assess for any aberrant drainage pattern to the left atrium and to prepare for potentially challenging instrument navigation through the coronary sinus.
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Affiliation(s)
- Spencer B Lewis
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Guy E Johnson
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Karim Valji
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
- Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA, 9810, USA
| | - Christopher R Ingraham
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
| | - Jeffrey Forris Beecham Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA
- Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA, 9810, USA
| | - David S Shin
- Division of Interventional Radiology, Department of Radiology, University of Washington, 1959 Northeast Pacific Street, Seattle, WA, 98195, USA.
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Tang Z, Teng Y, Li J, Du X, Xiao J, Tang G. Left upper lung cancer with persistent left superior vena cava and left azygos vein: a case report. J Cardiothorac Surg 2020; 15:254. [PMID: 32928265 PMCID: PMC7490884 DOI: 10.1186/s13019-020-01278-w] [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: 03/22/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023] Open
Abstract
Background With the popularization of thoracoscopic surgery, more and more macrovascular malformations have been reported. Understanding some vascular malformations with relatively fixed anatomical site and their range of drainage could avoid severe complications during the surgery. Persistent left superior vena cava (PLSVC) is a common thoracic vascular malformation, and is always combined with other cardiovascular dysplasia. As for the patient with upper left lung cancer in this case, he had PLSVC and left azygos vein, and non-metastatic enlargement of the lymph nodes at the same time, which had influenced the decisions on surgery and treatment. We made a summary of experience regarding this. Case presentation A 46-years-old male patient, his CT found a space-occupying lesion in the superior lobe of the left lung. The chest CT showed that the patient had PLSVC and left azygos vein, and multiple enlarged lymph nodes in the mediastinum. The patient received thoracoscopic upper left lung lobectomy and lymph node dissection. It was discovered that the left azygos vein had a concealed form, which influenced the lymph node dissection. The post-surgery pathology showed that there was squamous cell carcinoma in the upper left lung (pT2bN0M0 p Phase IIA) and no cancer metastasis with the lymph nodes. The patient had a good post-surgery recovery. Conclusions PLSVC is not rare, and is always combined with other vascular malformations. If discovering PLSVC before surgery, we suggest completing chest enhanced CT and vascular reconstruction, to find out other cardiovascular malformations that may exist. Left azygos vein is a rare vascular malformation, but it has a relatively fixed anatomical site, and always co-exists with PLSVC, therefore, understanding anatomy of left azygos vein is good for preventing accidental damage. Especially when performing surgery above the left pulmonary artery trunk, attention shall be paid to preventing damage to the left azygos vein. In addition, as for the patient with the diagnosis of lung cancer before surgery, it is not reliable to judge whether there is metastasis or not merely according to the size of the lymph nodes, instead, PET-CT or needle biopsy is recommended.
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Affiliation(s)
- Zhongben Tang
- Department of Thoracic, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Guiyang, 550004, Guizhou, China.
| | - Yin Teng
- Department of Thoracic, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Guiyang, 550004, Guizhou, China
| | - Jian Li
- Department of Thoracic, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Guiyang, 550004, Guizhou, China
| | - Xiaojun Du
- Department of Thoracic, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Guiyang, 550004, Guizhou, China
| | - Jiarong Xiao
- Department of Thoracic, The Affiliated Hospital of Guizhou Medical University, 28 Guiyi Street, Guiyang, 550004, Guizhou, China
| | - Gongshun Tang
- Department of Imaging, West China Hospital Sichuan University, 37 Guoxuexiang Street, Wuhou District, Chengdu, 610041, China
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Miyazaki A, Negishi J, Hayama Y, Tsuda E, Yamada O, Ichikawa H, Uemura H, Ohuchi H. Etiology of atrial fibrillation in patients with complex congenital heart disease - for a better treatment strategy. J Cardiol 2020; 76:438-445. [PMID: 32703716 DOI: 10.1016/j.jjcc.2020.06.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The demographics of patients with congenital heart disease (CHD) and atrial fibrillation (AF) differ significantly from the general population. The etiology and treatment strategy for AF in CHD patients have been investigated but are to date inconclusive. METHODS To determine the etiology of AF in CHD and to seek a better treatment strategy, we retrospectively evaluated the atrial overload in 42 complex CHD cases with normal atrial arrangements and AF (age 25; range, 9-66 years) and the impact of a reduction in the atrial overload on the atrial rhythm. RESULTS Cardiac defect diagnoses varied, with 17% of the patients having a persistent left superior vena cava (PLSVC). In regard to the volume overload, the frequencies of an overload in the right atrium (RA), left atrium (LA), or both, were 50 %, 23%, and 10%, respectively (p = 0.015). Other sustained supraventricular tachycardias were observed in 29 patients (69%) before and after the onset of AF. Among these 29 patients, 26 had intra-atrial reentrant tachycardia. Fifteen patients (36%), 10 of whom had chronic AF, died during the follow-up including 3 with arrhythmias and 10 because of heart failure. Fourteen (33%) patients had no AF at the last follow-up due to medical interventions, 8 of which underwent solely an RA-sided catheter ablation and/or surgical RA overload reduction. CONCLUSIONS AF in complex CHD with a normal atrial arrangement correlates with a higher RA-sided overload than an LA-sided and exhibits a high incidence of PLSVCs, high comorbidity of intra-atrial reentrant tachycardias, and high mortality rate. In a substantial number of patients, RA-sided interventions were effective in controlling AF. To effectively manage AF in complex CHD it is essential to understand each individual's hemodynamics and consider hemodynamic interventions.
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Affiliation(s)
- Aya Miyazaki
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan; Department of Transition Medicine, Division of Congenital Heart Disease, Shizuoka General Hospital, Shizuoka, Japan; Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Jun Negishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yohsuke Hayama
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Osamu Yamada
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hajime Ichikawa
- Department of Pediatric Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hideki Uemura
- Congenital Heart Disease Center, Nara Medical University, Nara, Japan
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Ichikawa T, Hara T, Koizumi J, Nakamura N, Nagafuji Y, Furuya H, Mikami T, Kuroki T, Hashimoto J. Persistent left superior vena cava with absent right superior vena cava in adults: CT and clinical findings. Jpn J Radiol 2020; 38:1046-51. [PMID: 32666181 DOI: 10.1007/s11604-020-01013-4] [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] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Persistent left superior vena cava (PLSVC) with absent right superior vena cava (ARSVC) is rare. We evaluated CT and clinical findings of adults with ARSVC. MATERIALS AND METHODS Our study included 11 adults with ARSVC (mean age, 63 ± 17 years). We evaluated CT findings of the azygos vein system and coronary sinus (CS) using thin slice data of > 64 MDCT. Arrhythmia and congenial heart disease were assessed. We compared the CS diameters between the ARSVC group and the control group of 120 adults with normal vena cava (mean age, 60 ± 4 years). RESULTS Adults with ARSVC had no azygos vein arch and the hemiazygos vein continued to PLSVCs via the superior intercostal vein. Eight adults had arrhythmia including conduction disturbance and one arrhythmia was associated with atrial septal defect. All adults with ARSVC had dilated CS larger than 11 mm. The mean diameter of the CS in the ARSVC group was 18.4 mm, and that of the control group was 6.8 mm. CS diameter in the ARSVC group was larger than that in the control group (p < 0.001). CONCLUSION Adults with ARSVC had dilated CS and no azygos vein arch. Four adults had conduction disturbance.
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