PURPOSE: To evaluate by meta-analysis the safety and efficacy of venous sac embolization (VSE) with or without feeding artery embolization versus feeding artery embolization (FAE) alone in the management of pulmonary arteriovenous malformations (PAVMs). METHODS: This systematic review and meta-analysis was performed and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A systematic literature search was performed in MEDLINE, Embase, and Scopus till August 31, 2021 to identify studies comparing the safety and efficacy of VSE with or without FAE versus FAE alone in PAVMs. The success of treatment was assessed by comparing the number of PAVMs with ≥70% decrease in the size of draining vein/sac between the 2 groups. The pooled odds ratio (OR) and 95% confidence interval (95% CI) were calculated using the random-effects inverse-variance model and were used to compare pooled therapeutic efficacy between the groups. RESULTS: Three studies were found eligible for the meta-analysis. The included studies had a total of 169 patients (119 females and 50 males). The total number of PAVMs was 298, and hereditary hemorrhagic telangiectasia was present in 119 patients. The success of treatment was higher with VSE as compared to FAE (OR=3.54, 95% CI=1.66-7.56). The minor complications were similar in both groups, and one major complication occurred in the FAE group. More coils were used in the VSE group. CONCLUSIONS: The present systematic review and meta-analysis has consolidated the evidence that VSE with or without FAE is more efficacious than FAE alone in the management of PAVMs without any increase in the associated risk of sac rupture or coil migration. CLINICAL IMPACT: Until high-quality data from a prospective, multicentric, randomized controlled trial becomes available, the evidence consolidated by the present systematic review and meta-analysis showing the efficacy of venous sac embolization (with or without feeding artery embolization) over feeding artery embolization alone, can be used for clinical decision-making in the management of pulmonary arterio-venous malformations.
Aneurysm , Aortic Aneurysm, Thoracic , Aneurysm/complications , Aneurysm/diagnostic imaging , Aorta , Aorta, Thoracic/abnormalities , Aorta, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/complications , Aortic Aneurysm, Thoracic/diagnostic imaging , Aortic Aneurysm, Thoracic/surgery , Humans , Subclavian Artery/abnormalities , Subclavian Artery/diagnostic imaging , Vertebral Artery/abnormalities , Vertebral Artery/diagnostic imaging
BACKGROUND: Double chambered right ventricle with perimembranous ventricular septal defect is rare. AIMS AND MATERIAL METHODS: We report a case of double chambered right ventricle, perimembranous ventricular septal defect with nonruptured sinus of valsalva aneurysm in a 17 year old acyanotic male. RESULTS, DISCUSSION: On transthoracic echocardiography subaortic ventricular septal defect potentially restricted by prolapse of right coronary sinus was found. Computed tomography angiography revealed perimembranous ventricular septal defect, unruptured right sinus of valsalva aneurysm, prolapsing into right ventricle through membranous septal defect. Thick muscular band was dividing right ventricle into two chambers-suggestive of double chamber right ventricle. CONCLUSION: We report a case of double chambered right ventricle with perimembranous ventricular septal defect and nonruptured sinus of valsalva aneurysm, this combination is not reported in literature prior.
Aortic Aneurysm , Heart Septal Defects, Ventricular , Sinus of Valsalva , Adolescent , Aortic Aneurysm/complications , Aortic Aneurysm/diagnostic imaging , Aortic Aneurysm/surgery , Echocardiography , Heart Septal Defects, Ventricular/diagnostic imaging , Heart Septal Defects, Ventricular/surgery , Heart Ventricles/diagnostic imaging , Humans , Male , Sinus of Valsalva/diagnostic imaging , Sinus of Valsalva/surgery
BACKGROUND: Ruptured interventricular septal aneurysms are rare. We present a case of an interventricular membranous septal aneurysm in a 7-year-old boy who presented with features of congestive heart failure, 2 years after undergoing a patch closure of perimembranous ventricular septal defect and tricuspid valve repair. Material and methods and results: Transthoracic echocardiography suggested the presence of an aneurysm that has ruptured into the right ventricle (RV), however, the precise origin of the aneurysm could not be identified on echocardiography. Subsequently, a computed tomography (CT) angiography was done which revealed that the aneurysm was originating from the membranous interventricular septum with evidence of rupture into the RV inflow. DISCUSSION: Due to its close proximity to the aortic annulus, an aneurysm of the membranous interventricular septum may be confused with a sinus of Valsalva aneurysm, especially if the former is associated with aortic regurgitation. CONCLUSION: This case highlights the importance of CT in the precise differentiation of these two abnormalities.
Aortic Aneurysm , Heart Septal Defects, Ventricular , Sinus of Valsalva , Ventricular Septum , Child , Echocardiography , Heart Septal Defects, Ventricular/diagnostic imaging , Heart Septal Defects, Ventricular/surgery , Humans , Male , Multidetector Computed Tomography , Ventricular Septum/diagnostic imaging , Ventricular Septum/surgery
We present a case of berry syndrome and bovine aortic arch in a 2-month old child, detected on multidetector computed tomography.
Aorta, Thoracic , Aorta , Aorta, Thoracic/diagnostic imaging , Aorta, Thoracic/surgery , Humans , Infant , Multidetector Computed Tomography , Syndrome
Variations in pulmonary venous anatomy (in the absence of any anomalous pulmonary venous connections) is not uncommon. Commonly occurring variations include presence of conjoined pulmonary veins (PV), supernumerary PVs and ostial PVs. Variant PV anatomy is often asymptomatic; however, it may assume importance in the pre-procedural planning prior to cardiothoracic surgeries and radiofrequency catheter-directed ablation for PV isolation. It is therefore important that the radiologist is aware of the conventional normal and variant PV anatomy in addition to obvious abnormalities like anomalous PV drainage or PV stenosis/ occlusion. Multidetector CT (MDCT) is often used as the first-line imaging modality for pre-procedural PV mapping as it provides high quality images with short acquisition times and availability of numerous post-processing tools.This pictorial review focusses on the MDCT-based PV imaging describing the reporting nomenclature, the conventional normal as well as non-anomalous variant PV anatomy along with their clinical significance.
Anatomic Variation , Computed Tomography Angiography , Multidetector Computed Tomography , Pulmonary Veins/anatomy & histology , Pulmonary Veins/diagnostic imaging , Humans , Radiology/methods
We hereby present a case of divided left atrium with mitral valve prolapse and discuss the hemodynamic consequences that ensue. This case demonstrates the utility of computed tomography angiography in identifying such associations.
Computed Tomography Angiography , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnostic imaging , Mitral Valve Prolapse/complications , Mitral Valve Prolapse/diagnostic imaging , Adult , Heart Atria , Humans , Male , Mitral Valve Insufficiency/genetics , Young Adult
Abnormalities, Multiple , Coronary Sinus/abnormalities , Vascular Malformations/diagnosis , Vena Cava, Superior/abnormalities , Adult , Coronary Sinus/diagnostic imaging , Coronary Vessel Anomalies/diagnosis , Diagnosis, Differential , Female , Humans , Tomography, X-Ray Computed , Vena Cava, Superior/diagnostic imaging
Aneurysm/etiology , Calcinosis/etiology , Cardiac Surgical Procedures/adverse effects , Postoperative Complications/diagnosis , Pulmonary Artery , Tetralogy of Fallot/surgery , Adult , Aneurysm/diagnosis , Aneurysm/surgery , Calcinosis/diagnosis , Calcinosis/surgery , Humans , Male , Postoperative Complications/surgery , Reoperation , Tomography, X-Ray Computed