Developmental anomalies of the superior vena cava and its tributaries: What the radiologist needs to know?

Deviations from the normal process of embryogenesis can result in various developmental anomalies of the superior vena cava (SVC). While these anomalies are often asymptomatic, they assume clinical importance during interventions such as central venous catheterisations and pacemaker implantations and during cardiothoracic surgeries while instituting cardiopulmonary bypass and for creation of cavo-pulmonary connections. Role of imaging in identifying these anomalies is indispensable. Cross-sectional imaging techniques like CT venography and magnetic resonance (MR) venography allow direct visualisation and consequently increased detection of anomalies. CT venography plays an important role in detection of SVC anomalies as it is readily available, has excellent spatial resolution, short acquisition times and potential for reconstruction of images in multiple planes. This pictorial review focuses on the developmental anomalies of the SVC and its tributaries highlighting their embryological basis, imaging appearances on CT venography and potential clinical implications, where relevant.

Isolation of arch vessels: Imaging characteristics and associations on multidetector computed tomography angiography.

AIM: To evaluate the imaging characteristics and associations in patients with isolation of arch vessels on multidetector computed tomography angiography (CTA). MATERIALS AND METHODS: We retrospectively reviewed all multidetector CTA studies performed for the evaluation of congenital heart diseases (CHDs) at our institution from January 2014 to June 2020. Cases with isolation of arch vessels were identified. The isolated arch artery and its relationship with patent arterial duct, pulmonary artery, and aortic arch were characterized in addition to other associated intra- and extracardiac anomalies. RESULTS: Isolation of arch vessels was seen in 14/3926 (0.36%) patients. Left subclavian artery (SCA) was the commonest isolated arch vessel, involved in 7/14 (50%) cases. Isolation of right SCA, left brachiocephalic artery, and left common carotid artery was seen in 4 (28.6%), 2 (14.3%), and 1 (7.1%) patient, respectively. The isolated arch vessel was seen associated with right aortic arch in 10/14 (71.4%) cases and was on the opposite side of aortic arch in all 14 (100%) patients. Right-sided nonrestrictive patent arterial duct was seen in 3/14 (21.4%) cases, left-sided nonrestrictive patent arterial duct was seen in 1/14 (7.1%) while a left-sided restrictive patent arterial duct was seen in 3/14 (21.4%) cases. Tetralogy of Fallot (ToF) was the commonest associated anomaly seen in 8/14 (57.1%) patients. CONCLUSION: Isolation of aortic arch branch vessels is rare, seen most commonly associated with ToF. Left SCA is the commonest involved vessel. CTA is useful not only in the diagnosis of isolation of arch vessels, but also in the presence or absence of associated anomalies which may impact the symptomatology, prognosis, and surgical management.

A study of cardiovascular risk factors and its knowledge among school children of Delhi.

BACKGROUND: Data on the knowledge of cardiovascular risk factors among Indian school children are limited. Aim of the study was to assess the prevalence of cardiovascular risk factors and its knowledge among school children of Delhi. METHODS: We performed a cross-sectional survey among 485 school children studying in classes 6, 7 and 8 in two government and one private school in New Delhi using convenience sampling. Cardiovascular risk factors (physical activity, diet and smoking), knowledge about risk factors and family profile were assessed using a structured self report questionnaire. Weight, height and blood pressure measurements were taken. RESULTS: The mean age of the studied school children was 12.8 ± 1.6 years. The prevalence of overweight and obesity was 9.5% and 11.5% respectively. The prevalence of prehypertension, stage 1 hypertension and stage 2 hypertension was 12.4%, 6.8% and 1.4% respectively. Of the total, 43.8% were physically active for at least 1 hour per day on all 7 days of the previous week. Daily consumption of fruits and vegetables was reported by 42% and 76% of the school children respectively. Nearly 5% of the school children reported to have used any form of tobacco. One fifth of the school children had a family history of cardiovascular disease. Of the total, 25.4% had adequate knowledge regarding cardiovascular risk factors. CONCLUSION: Cardiovascular risk factors are highly prevalent among school children. Importantly, school children lack adequate knowledge regarding cardiovascular risk factors. School based interventions are required for cardiovascular risk reduction in childhood.

Transvenous closure of large aortopulmonary collateral.

Aortopulmonary collaterals (APCs) are occluded either preoperatively or at the time of cardiac surgery in patients with pulmonary atresia and ventricular septal defect (PAVSD). If left untreated, APCs are an important cause of deterioration in the early postoperative period. We present here an unusual case with a large residual APC causing refractory low-output state in the early postoperative period. Usual arterial approach failed due to extensive angulation with ostial narrowing. The large residual APC was successfully closed with an Amplatzer duct occluder (ADO) device delivered through the transvenous route.