Assuntos
Veia Cava Superior Esquerda Persistente , Humanos , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Veia Cava Superior Esquerda Persistente/complicações , Masculino , Feminino , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/anormalidades , Pessoa de Meia-Idade , AdultoRESUMO
Intrahepatic interruption of the inferior vena cava (IVC) with continued hemizygous is a very rare abnormality and sometimes it may be accompanied by other cardiovascular abnormalities. Continuation of the hemizygous vein draining into the right atrium through the left superior vena cava (LSVC) is much rarer. In this paper, we have presented a patient who had simultaneous IVC interrupted with persistent LSVC and suffered from Atrioventricular nodal reentrant tachycardia (AVNRT). Finally, radiofrequencies (RF) catheter ablation for AVNRT was successfully performed through a left subclavian vein access.
Assuntos
Ablação por Cateter , Veia Cava Superior Esquerda Persistente , Taquicardia por Reentrada no Nó Atrioventricular , Veia Cava Inferior , Adulto , Feminino , Humanos , Veia Ázigos/anormalidades , Veia Ázigos/cirurgia , Ablação por Cateter/métodos , Veia Cava Superior Esquerda Persistente/cirurgia , Veia Cava Superior Esquerda Persistente/complicações , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia por Reentrada no Nó Atrioventricular/fisiopatologia , Veia Cava Inferior/anormalidades , Veia Cava Inferior/cirurgia , Veia Cava Superior/anormalidades , Veia Cava Superior/cirurgiaRESUMO
ABSTRACT: Isolated persistent left superior vena cava (PLSVC) is a very rare congenital thoracic venous system anomaly and is commonly an incidental finding, usually detected during central venous access, cardiac catheterization, or cardiothoracic surgeries. This is a rare case report wherein the patient is a known case of ischemic heart disease with s/p percutaneous transluminal coronary angioplasty (PTCA) with a stent to left anterior descending (LAD) artery with in-stent re-stenosis presented with complete heart block and had an unanticipated discovery of isolated PLSVC on facing difficulty during the transvenous approach of permanent pacemaker implantation (PPI). In this case report, we inspect the challenges associated with and various clinical implications of isolated PLSVC.
Assuntos
Bloqueio Cardíaco , Isquemia Miocárdica , Veia Cava Superior Esquerda Persistente , Stents , Humanos , Isquemia Miocárdica/cirurgia , Bloqueio Cardíaco/terapia , Veia Cava Superior Esquerda Persistente/complicações , Masculino , Angioplastia Coronária com Balão/métodos , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
Guidewire loss is a rare complication of central venous catheterization. A 65-year-old male was hospitalized in a high-dependency unit for exacerbation of chronic obstructive pulmonary disease, pneumonia, erythrocytosis, and clinical signs of heart failure. Upon admission, after an unsuccessful right jugular approach, a left jugular central venous catheter was placed. The next day, chest radiography revealed the catheter located in the left parasternal region, with suspected retention of the guidewire, visually confirmed by the presence of its proximal end inside the catheter. The left parasternal location of the catheter and the typical projection of the guidewire in the coronary sinus, later confirmed by echocardiography, raised suspicion of a persistent left superior vena cava (PLSVC). Agitated saline injected into the left antecubital vein confirmed bubble entry from the coronary sinus into the right atrium. After clamping the guidewire, the catheter was carefully retrieved along with the guidewire without any complications. This is the first reported case of guidewire retention in PLSVC and coronary sinus. It underscores the potential causes of guidewire loss and advocates preventive measures to avoid this potentially fatal complication.
Assuntos
Cateterismo Venoso Central , Cateteres Venosos Centrais , Seio Coronário , Remoção de Dispositivo , Veia Cava Superior Esquerda Persistente , Humanos , Masculino , Idoso , Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/efeitos adversos , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Veia Cava Superior Esquerda Persistente/terapia , Resultado do Tratamento , Cateteres de Demora , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem , FlebografiaAssuntos
Ecocardiografia , Veia Cava Superior Esquerda Persistente , Humanos , Ecocardiografia/métodos , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagemAssuntos
Cateterismo de Swan-Ganz , Veia Cava Superior , Humanos , Masculino , Cateterismo de Swan-Ganz/instrumentação , Cateterismo de Swan-Ganz/métodos , Ecocardiografia/métodos , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Ultrassonografia de Intervenção/métodos , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem , AdultoRESUMO
BACKGROUND: Isolated agenesis of ductus venosus (ADV) is usually a benign condition, but it may be associated with cardiovascular defects, hydrops, growth restriction, and chromosomal abnormalities. Additionally, persistent left superior vena cava (PLSVC) and bovine aortic arch are relatively common fetal anomalies. To the author's knowledge, this is the first report of prenatal detection of DV agenesis and PLSVC associated with the postnatal bovine aortic arch with a hypoplastic transverse aortic arch. CASE: A 25-year-old, G2P1 woman was referred to our department at 31 weeks due to fetal growth restriction and short femur. On fetal echocardiography, DV could not be viewed via two-dimensional (2D) and Doppler ultrasound (US) imaging; there was also evidence of the co-occurrence of PLSVC and an aortic arch anomaly. We revealed the intrahepatic continuation of the umbilical vein. A weekly follow-up program was scheduled for the patient and the rest of the pregnancy was uneventful. Postnatal, thorax computer tomography and transthoracic echocardiography (TTE) demonstrated PLSVC and bovine aortic arch associated with hypoplastic transverse aortic arch. Routine echocardiographic examinations revealed that the blood flow of the aortic arch had increased gradually, and the male infant's aortic arch had significantly widened and reached the normal range until the baby was discharged from the hospital. CONCLUSION: DV agenesis and PLSVC are usually benign conditions but underlying serious heart diseases may accompany them. Therefore, in situations like ours, a prenatal aortic arch evaluation is of capital importance. Postnatal hemodynamic changes should be taken into consideration in the management of these cases. This is the first example in the literature that these abnormalities co-existed in one case.
Assuntos
Aorta Torácica , Ultrassonografia Pré-Natal , Feminino , Humanos , Aorta Torácica/anormalidades , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/embriologia , Gravidez , Adulto , Recém-Nascido , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Veia Cava Superior Esquerda Persistente/complicações , Anormalidades Múltiplas/diagnóstico por imagem , Veias Umbilicais/anormalidades , Veias Umbilicais/diagnóstico por imagem , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagem , Ecocardiografia , MasculinoRESUMO
BACKGROUND: Persistent left superior vena cava (PLSVC) is the most prevalent form of thoracic venous abnormality and can serve as a significant arrhythmogenic source in atrial fibrillation (AF). METHODS AND RESULTS: Among the 3950 patients who underwent radiofrequency ablation for AF between September 2014 to April 2020, 17 patients (mean age 59.4 ± 8.0 years, 64.7% male) with PLSVC were identified. Among them, nine patients (52.9%) had a prior history of pulmonary vein isolation (PVI) alone. Eight out of nine patients who experienced AF recurrence underwent PLSVC isolation with or without pulmonary vein (PV) reconnection. For the remaining eight patients (47.1%), PVI plus PLSVC isolation were performed during the index procedure. Ectopy originating from PLSVC was documented in 11 patients (64.7%) and successful PLSVC isolation was achieved in 16 patients (94.1%). After a median follow-up of 28.3 months, freedom from AF/ atrial tachycardia (AT) was observed in 13 patients (76.5%). CONCLUSION: Empirical PLSVC isolation beyond PVI appears to be a feasible and safe strategy to prevent AF recurrence in patients with concomitant PLSVC.
Assuntos
Fibrilação Atrial , Ablação por Cateter , Veia Cava Superior Esquerda Persistente , Veias Pulmonares , Taquicardia Supraventricular , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior , Ablação por Cateter/métodos , Veias Pulmonares/cirurgia , Recidiva , Resultado do TratamentoAssuntos
Embolia , Veia Cava Superior Esquerda Persistente , Veias Pulmonares , Acidente Vascular Cerebral , Humanos , Adulto , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/anormalidades , Veia Cava Superior Esquerda Persistente/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/etiologia , Embolia/complicaçõesAssuntos
Ablação por Cateter , Veia Cava Superior Esquerda Persistente , Taquicardia por Reentrada no Nó Atrioventricular , Humanos , Taquicardia por Reentrada no Nó Atrioventricular/cirurgia , Taquicardia por Reentrada no Nó Atrioventricular/etiologia , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior Esquerda Persistente/cirurgia , Veia Cava Superior/cirurgiaRESUMO
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.
Assuntos
Veia Cava Superior Esquerda Persistente , Síndrome de Wolff-Parkinson-White , Masculino , Humanos , Pessoa de Meia-Idade , Síndrome de Wolff-Parkinson-White/complicações , Síndrome de Wolff-Parkinson-White/cirurgia , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/anormalidades , Eletrocardiografia , Ecocardiografia/efeitos adversosRESUMO
BACKGROUND Castleman disease was first described in 1956 as mediastinal masses composed of benign lymphoid hyperplasia with germinal center formation and capillary proliferation closely resembling thymomas. It has been linked with many multi-system disorders, including myasthenia gravis. Cases of Castleman disease with corresponding myasthenia gravis have higher rates of postoperative myasthenic crisis, which are reported as high as 37.5%. We encountered a case of Castleman disease with myasthenia gravis that was discovered early and managed successfully with complete surgical resection and no postoperative myasthenic crisis. CASE REPORT A 25-year-old woman with an uncomplicated history presented with shortness of breath, numbness in hands, tiring with chewing, and fatigue. Myasthenia gravis was diagnosed with serology test results, and a 7.5×7.0-cm mediastinal mass was discovered in addition to the incidental finding of a persistent left superior vena cava, closely abutting the mass. Biopsy showed lymphoid proliferation, regressed germinal centers surrounded by small lymphocytes, and vascular proliferation, consistent with unicentric Castleman disease, hyaline-vascular type. The patient was successfully treated for Castleman disease with myasthenia gravis, and no postoperative myasthenic crisis occurred. CONCLUSIONS Castleman disease associated with myasthenia gravis can dramatically increase the risk of postoperative myasthenic crisis. Our literature review of all 16 cases of Castleman disease with myasthenia gravis since 1973 revealed that 18.75% of cases were associated with a postoperative myasthenic crisis. This association elicits the importance of prompt diagnosis of myasthenia gravis when evaluating mediastinal masses and the value of having neurology and anesthesiology staff aware of the increased risk of crisis.
Assuntos
Hiperplasia do Linfonodo Gigante , Miastenia Gravis , Veia Cava Superior Esquerda Persistente , Neoplasias do Timo , Feminino , Humanos , Adulto , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/diagnóstico , Hiperplasia do Linfonodo Gigante/cirurgia , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior , Miastenia Gravis/complicações , Miastenia Gravis/diagnósticoRESUMO
INTRODUCTION: In this study, we present a case of directing persistent left superior vena cava drainage into the unroofed coronary sinus to the right atrium in a patient with tetralogy of Fallot and coronary sinus orifice atresia without innominate vein. CASE REPORT: A 16-month-old boy diagnosed with tetralogy of Fallot was admitted. Following intracardiac repair, the left superior vena cava was divided from the left atrial junction, passed through under the ascending aorta and anastomosed to the right superior vena cava. CONCLUSION: To our knowledge, this is the first patient reported with persistent left superior vena cava, unroofed coronary sinus, coronary sinus orifice atresia, and tetralogy of Fallot. The extracardiac direct anastomosis technique was used successfully to direct persistent left superior vena cava to the right atrium without any post-procedure complications.
Assuntos
Seio Coronário , Anomalias dos Vasos Coronários , Cardiopatias Congênitas , Comunicação Interatrial , Veia Cava Superior Esquerda Persistente , Tetralogia de Fallot , Masculino , Humanos , Lactente , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/cirurgia , Veia Cava Superior/anormalidades , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia , Veia Cava Superior Esquerda Persistente/complicações , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Seio Coronário/anormalidades , Cardiopatias Congênitas/complicações , Comunicação Interatrial/complicações , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgiaRESUMO
Vascular injury associated with cannulation during extracorporeal membrane oxygenation (ECMO) induction is a rare but life-threatening complication. The presence of abnormal vascular anatomy increases the risk of vascular injury and should be recognized before cannulation. We report the case of a patient with coronavirus disease (COVID-19) who was expected to undergo ECMO. By performing computed tomography (CT), we identified the absence of right superior vena cava (RSVC) with a persistent left superior vena cava (PLSVC) that could have caused serious complications associated with ECMO cannulation. PLSVC is observed in less than 0.5% of the general population; however, the combination of PLSVC and an absent RSVC in visceroatrial situs solitus is extremely rare. Attempting cannulation for Veno-venous (VV)-ECMO from the right (or left) internal jugular vein to the right atrium may cause serious complications. Cannulation may fail or lead to complications even in patients with inferior vena cava malformations. Although these vascular abnormalities are rare, it is possible to avoid iatrogenic vascular injury by identifying their presence in advance. Since anatomical variations in the vessels from the deep chest and abdominal cavity cannot be visualized using chest radiography and ultrasonography, we recommend CT, if possible, for patients with severe respiratory failure, including those with COVID-19, who may be considered for VV-ECMO induction.
Assuntos
COVID-19 , Veia Cava Superior Esquerda Persistente , COVID-19/terapia , Oxigenação por Membrana Extracorpórea , Humanos , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Veia Cava Superior/anormalidades , Veia Cava Superior/diagnóstico por imagemRESUMO
Persistent left superior vena cava (PLSVC) poses technical challenges to implantation of transvenous cardiac implantable electronic devices. His-bundle pacing is a physiologic pacing strategy to avoid or treat pacing-induced cardiomyopathy. We report a case of His-bundle lead implantation in a patient with PLSVC, absent right SVC, and pacing-induced cardiomyopathy.
Assuntos
Fascículo Atrioventricular/fisiopatologia , Cardiomiopatias/etiologia , Marca-Passo Artificial , Veia Cava Superior Esquerda Persistente/complicações , Cardiomiopatias/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Marca-Passo Artificial/efeitos adversosRESUMO
Platypnea-Orthodeoxia syndrome (POS) is a rare clinical syndrome characterized by shortness of breath in the upright position that is relieved with supine positioning. We present a rare case of persistent left superior vena cava (PLSVC) draining into the left atrium causing a right-to-left shunt and subsequent POS. A 30-year-old female with a past medical history of hypertrophic cardiomyopathy, congenital Long QT syndrome and a left-sided dual chamber implantable cardioverter-defibrillator (ICD) presented with dyspnea and lightheadedness. Prior to presentation, the patient underwent a left-sided ICD extraction due to ICD lead infection and re-implantation from the right side through the cephalic vein. After further investigation, it was concluded that the PLSVC resulted in a physiological right-to-left shunting causing POS, with resolution of her symptoms after surgical ligation. To our knowledge, this is the first case report of PLSVC presenting with POS without anatomical intracardiac shunts following iatrogenic right superior vena cava (RSVC) obstruction.
Assuntos
Dispneia/etiologia , Hipóxia/etiologia , Marca-Passo Artificial , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior Esquerda Persistente/cirurgia , Postura , Adulto , Fibrilação Atrial/cirurgia , Diagnóstico por Imagem , Feminino , Humanos , SíndromeRESUMO
Persistent left superior vena cava (PLSVC) is the most common congenital intrathoracic venous anomaly with significant clinical relevance. In the vast majority of cases, it is asymptomatic and diagnosed after noticing an abnormal course of central venous access device on a routine post-procedure roentgenogram. It may also be accidentally discovered after facing difficulty in accessing the right side of the heart from a left internal jugular vein or left subclavian vein approach, a common site of access while placing cardiac pacemaker and Swan-Ganz catheter, or after a complication associated with hemodialysis (HD) catheter insertion. HD through a catheter in PLSVC has its own set of pitfalls and should be reserved for short-term dialysis at the best. In this case report, we present a scenario where PLSVC was discovered after the placement of a tunneled HD catheter.
Assuntos
Cateterismo Venoso Central , Veia Cava Superior Esquerda Persistente , Diálise Renal , Adulto , Feminino , Humanos , Veia Cava Superior Esquerda Persistente/complicaçõesRESUMO
A 49-year-old female patient presented with acute-on-chronic chest pain. She was diagnosed with multiple systemic thromboemboli, including myocardial infarctions, bilateral chronic pulmonary emboli, ischaemic stroke, deep venous thrombosis and superficial thrombophlebitis. She had a background of sickle cell trait. Cardiac magnetic resonance showed bilateral superior vena cava (SVC). The right-sided SVC (RSVC) was joined by the right upper pulmonary vein and drained anomalously into the left atrium. This caused a small volume right to left shunt. The persistent left SVC drained into the right atrium (RA) via a dilated coronary sinus. The overall clinical impression was recurrent paradoxical emboli due to anomalous venous anatomy with a thrombophilia secondary to sickle cell trait. In the normal embryo, the right common cardinal vein develops to become the RSVC, which drains into the RA by term.
Assuntos
Embolia Paradoxal/etiologia , AVC Isquêmico/etiologia , Infarto do Miocárdio/etiologia , Veia Cava Superior Esquerda Persistente/complicações , Embolia Pulmonar/etiologia , Traço Falciforme/complicações , Trombofilia/complicações , Tromboflebite/etiologia , Trombose Venosa/etiologia , Ecocardiografia , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Recidiva , Malformações Vasculares/complicações , Malformações Vasculares/diagnóstico por imagemRESUMO
A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to 'think horses and not zebras', and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.
Assuntos
COVID-19/diagnóstico , Dor no Peito/fisiopatologia , Dispneia/fisiopatologia , Comunicação Interatrial/diagnóstico por imagem , Hipertensão Pulmonar/diagnóstico por imagem , Hipertrofia Ventricular Direita/diagnóstico por imagem , Veia Cava Superior Esquerda Persistente/diagnóstico por imagem , Síndrome de Cimitarra/diagnóstico por imagem , Adulto , Cateterismo Cardíaco , Dor no Peito/etiologia , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Diagnóstico Diferencial , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Dilatação Patológica/fisiopatologia , Dispneia/etiologia , Ecocardiografia , Eletrocardiografia , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/fisiopatologia , Hipertrofia Ventricular Direita/complicações , Hipertrofia Ventricular Direita/fisiopatologia , Imageamento por Ressonância Magnética , Veia Cava Superior Esquerda Persistente/complicações , Veia Cava Superior Esquerda Persistente/fisiopatologia , SARS-CoV-2 , Síndrome de Cimitarra/complicações , Síndrome de Cimitarra/fisiopatologia , Tomografia Computadorizada por Raios X , Pressão VentricularRESUMO
Double-outlet right ventricle is a conotruncal cardiac disease in which both the aorta and the pulmonary artery predominantly or completely originate from the right ventricle. Here, we report a complex variant double-outlet right ventricle detected in utero and identified on the basis of a segmental approach.