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1.
Radiol Med ; 125(3): 237-246, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31823296

RESUMO

Persistent left-sided superior vena cava (PLSVC) is the commonest systemic venous anomaly in the thorax with a reported prevalence of up to 0.5% in otherwise normal population and up to 10% in patients with congenital heart disease (CHD). In the absence of associated CHD, it is usually asymptomatic, discovered incidentally. It may complicate catheter or pacemaker lead placement. PLSVC typically drains into the right atrium through the coronary sinus. In children with CHD, the presence of a PLSVC may affect the choice of certain surgical procedures. PLSVC is significantly more common in association with situs ambiguous than with situs solitus or inversus, up to 60-70%. In patients with situs ambiguous, the drainage of LSVC is variable, more commonly directly into the atria rather than through the coronary sinus (CS). Rarely, there is a PLSVC draining into the CS with absent right SVC. PLSVC draining into the right atrium via the CS will not usually cause blood shunting between the right and the left sides. However, shunting occurs when PLSVC is associated with unroofed CS, or when it directly drains into the left atrium. With an increased use of CT and MRI for chest and cardiac imaging, PLSVC is being more encountered by radiologists than before. In this article, we will discuss the embryology of PLSVC, its anatomic course and drainage pathways, as well as its clinical relevance and relation to congenital heart disease and viscero-atrial situs.


Assuntos
Cardiopatias Congênitas/complicações , Veia Cava Superior/anormalidades , Adolescente , Doenças Assintomáticas , Veias Braquiocefálicas/embriologia , Criança , Pré-Escolar , Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Feminino , Síndrome de Heterotaxia/complicações , Humanos , Achados Incidentais , Lactente , Imagem por Ressonância Magnética , Masculino , Circulação Pulmonar , Fluxo Sanguíneo Regional , Situs Inversus/complicações , Tomografia Computadorizada por Raios X , Veia Cava Inferior/anormalidades , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/embriologia
2.
J Clin Ultrasound ; 48(1): 56-58, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31364173

RESUMO

Sinus venosus atrial septal defect (ASD) accounts for 5% to 10% of ASDs. In contrast with the more common superior vena cava (SVC) type, the inferior vena cava (IVC) type of sinus venosus ASD with overriding IVC is extremely rare. The sinus venosus defect occur posterior to the fossa ovalis and is not regarded as true ASD. Transesophageal echocardiography (TEE) is a diagnostic procedure of choice due to close proximity of atrial septum to TEE transducer. However; it may not constantly yield detailed anatomical and functional characterization, and other imaging modalities such as cardiac magnetic resonance imaging (MRI) may be needed. We report the case of a 45-year-old woman with an undiagnosed hemodynamically significant IVC-type ASD without any anomalous drainage of pulmonary veins, who presented with progressive dyspnea.


Assuntos
Ecocardiografia Transesofagiana , Comunicação Interatrial/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem , Diagnóstico Tardio , Feminino , Humanos , Pessoa de Meia-Idade , Veia Cava Inferior/anormalidades
3.
Vet Radiol Ultrasound ; 60(6): 680-688, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31509893

RESUMO

Computed tomography is increasingly used as a treatment planning method in canine patients with diseases of the retroperitoneum, however, published information on normal variations in the caudal vena cava (CVC) are currently lacking. The objectives of this retrospective descriptive study were to characterize CVC variants using CT angiography in a sample of small breed dogs and localize the CVC bifurcations for each variant. Inclusion criteria were small breed dogs (weight ≤ 15) that underwent contrast-enhanced CT scans of the CVC, abdominal aorta, and CVC tributaries. A total of 121 small breed dogs were sampled. Four right-sided and one left-sided CVC variations were identified: normal (88/121, 72.7%), caudal-partial split (17/121, 14.0%), partial duplication (8/121, 6.6%), complete duplication (7/121, 5.8%), and left-sidedness (1/121, 0.8%). The mean lumbar vertebral levels of the CVC bifurcation were L6.39 ± 0.41, L5.70 ± 0.35, L4.39 ± 0.42, L2.74 ± 0.38, and L6.4 in the normal, caudal-partial split, partial duplication, complete duplication, and left-sidedness types, respectively. The location of the CVC bifurcation, the relationship between the aortic trifurcation and the CVC bifurcation, and the location of the bilateral deep circumflex iliac veins with respect to the CVC bifurcation were significantly different among the right-sided types (P ≤ .001). Bilateral deep circumflex iliac veins joined to the ipsilateral common iliac veins and the CVC in the caudal-partial split and duplication types, respectively. The results of this study indicated that canine CVC variants may be frequent and should be considered during surgery or diagnostic imaging of the retroperitoneum.


Assuntos
Aorta Abdominal/anormalidades , Doenças do Cão/diagnóstico por imagem , Doenças Vasculares/veterinária , Veia Cava Inferior/anormalidades , Animais , Aorta Abdominal/diagnóstico por imagem , Cães , Feminino , Masculino , Linhagem , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/veterinária , Doenças Vasculares/diagnóstico por imagem , Veia Cava Inferior/diagnóstico por imagem
4.
World Neurosurg ; 132: 58-62, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479791

RESUMO

BACKGROUND: Oblique lumbar interbody fusion takes advantage of the wide interval between the aorta and left-sided psoas muscle to access the lumbar spine, allowing a minimally invasive approach for interbody fusion with lower associated morbidity. As this approach is gaining popularity among spine surgeons, it is important to understand the potential pitfalls that may arise in patients with congenital anomalies of the vascular anatomy. CASE DESCRIPTION: We present a case of a persistent left-sided inferior vena cava (IVC) affecting the side of approach in a patient undergoing lumbar interbody fusion through an oblique prepsoas retroperitoneal approach. Preoperative imaging of our patient revealed a persistent left-sided inferior vena cava with a wide interval between the aorta and the right-sided psoas, allowing us a right-sided oblique approach. CONCLUSIONS: Thorough preoperative imaging evaluation is essential to identify vascular anomalies that may hinder oblique prepsoas retroperitoneal approach to the lumbar spine. Although rare, double IVC or isolated left IVC may complicate the oblique approach.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Malformações Vasculares/diagnóstico por imagem , Veia Cava Inferior/anormalidades , Idoso , Humanos , Degeneração do Disco Intervertebral/diagnóstico por imagem , Vértebras Lombares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Estenose Espinal/diagnóstico por imagem , Malformações Vasculares/complicações , Veia Cava Inferior/diagnóstico por imagem
5.
Cardiol Young ; 29(10): 1310-1312, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475660

RESUMO

Femoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.


Assuntos
Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interatrial/cirurgia , Dispositivo para Oclusão Septal , Situs Inversus/diagnóstico , Cirurgia Assistida por Computador/métodos , Veia Cava Inferior/anormalidades , Pré-Escolar , Ecocardiografia Transesofagiana , Fluoroscopia , Comunicação Interatrial/diagnóstico , Humanos , Veias Jugulares , Masculino
7.
Vasc Endovascular Surg ; 53(7): 585-588, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31234733

RESUMO

We report a unique case of unusual drainage of the bifurcated retroaortic left renal vein, with the cranial wider branch draining into a dilated lumbar azygos vein and caudal thinner branch connecting with the inferior vena cava. The right renal vein was duplicated. The anomaly was discovered on multimodal 18F-labeled fluorodeoxyglucose positron emission tomography/computed tomography performed for oncological purposes. The basis enabling occurrence of such variation was probably persistent developmental extra left-right venous connections, intercardinal, or intersupracardinal, depending on the theory. The embryology of the chest and abdominal veins is a complicated process and there is no unanimity concerning its concepts. The old models are currently being questioned and reevaluated. Knowledge of possible variants of renal and azygos veins course is important from clinical, imaging, and surgical points of view. The retroaortic left renal veins course may sometimes cause pain, hematuria, proteinuria, and pelvic congestion syndromes. Dilated parts of uncommonly located veins, because of assuming a nodular shape on transverse images, may be mistaken for abnormal lymph nodes, other tumors or aneurysms on imaging. During a variety of surgical procedures, including venous sampling, renal transplantation, or any retroperitoneal surgery, knowledge of an aberrant venous course may be important for the success of the procedure and may be crucial even earlier during the qualification process.


Assuntos
Veia Ázigos/anormalidades , Veias Renais/anormalidades , Veia Cava Inferior/anormalidades , Idoso , Veia Ázigos/diagnóstico por imagem , Veia Ázigos/fisiopatologia , Dilatação Patológica , Fluordesoxiglucose F18/administração & dosagem , Humanos , Achados Incidentais , Masculino , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/administração & dosagem , Circulação Renal , Veias Renais/diagnóstico por imagem , Veias Renais/fisiopatologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia
9.
J Vet Cardiol ; 23: 112-121, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31174721

RESUMO

A 2-year-old intact female mixed breed dog was presented for ascites. Echocardiography demonstrated severe obstruction at the level of the caudal right atrium. Initially, a variant of cor triatriatum dexter was diagnosed, and balloon catheter dilation was performed. However, ascites recurred within a week. Further imaging revealed an obstruction at the entrance of the caudal vena cava into the right atrium rather than a dividing membrane in the right atrium. The diagnosis was revised to suprahepatic obstruction of the caudal vena cava because of remnant Eustachian valve tissue. Deployment of a balloon-expandable biliary stent was performed relieving the obstruction. Fifteen months after stent deployment, the patient is doing well without reaccumulation of ascitic fluid.


Assuntos
Doenças do Cão/terapia , Cardiopatias Congênitas/veterinária , Stents/veterinária , Animais , Ascite/veterinária , Cineangiografia/veterinária , Coração Triatriado/terapia , Doenças do Cão/congênito , Doenças do Cão/diagnóstico por imagem , Cães , Ecocardiografia/veterinária , Feminino , Átrios do Coração/anormalidades , Cardiopatias Congênitas/terapia , Veia Cava Inferior/anormalidades
10.
Int. j. morphol ; 37(2): 682-684, June 2019. graf
Artigo em Inglês | LILACS | ID: biblio-1002276

RESUMO

Complete duplication of testicular veins is a rare phenomenon. However, a few cases of duplication of gonadal veins have been reported. Here, I report a case of unusual formation and termination of the right testicular vein in an adult male cadaver. Five veins arose from the pampinniform plexus and entered the abdomen through the deep inguinal ring. The most medial among the five was large (3 mm in diameter) and it continued as a testicular vein and opened into the right edge of the inferior vena cava, 1 cm above the union of the common iliac veins. The other four veins were about 1 mm in diameter and they united to form two veins in front of the lower part of the right psoas and iliacus muscles (about 2 cm above the deep inguinal ring) and the two veins united to form upper testicular vein, 4 cm above the deep inguinal ring. This testicular vein was 3 mm in diameter and it opened into the inferior vena cava, 4 cm above the union of common iliac veins. Having five veins at deep inguinal ring might increase the chances of varicocele and decrease the chances of indirect inguinal hernia.


La duplicación completa de las venas testiculares es un fenómeno raro. Sin embargo, se han reportado algunos casos de duplicación de venas gonadales. En el presente trabajo se informa un caso de formación y terminación inusual de la vena testicular derecha en un cadáver de un hombre adulto. Cinco venas surgieron del plexo pampiniforme y penetraron en el abdomen a través del anillo inguinal profundo. El más medial entre los cinco fue de gran tamaño (3 mm de diámetro) y continuó como una vena testicular y se abrió hacia el margen derecho de la vena cava inferior, 1 cm por encima de la unión de las venas ilíacas comunes. Las cuatro venas restantes eran de 1 mm de diámetro aproximadamente, y se unieron para formar dos venas frente a la parte inferior de los músculos psoas e ilíaco derechos (aproximadamente 2 cm por encima del anillo inguinal profundo). Se unieron dos venas para formar la vena testicular superior, la cual medía 3 mm de diámetro y se abría hacia la vena cava inferior, 4 cm por encima de la unión de las venas ilíacas comunes. Cinco venas en el anillo inguinal profundo podrían aumentar las posibilidades de varicocele y disminuir las posibilidades de una hernia inguinal indirecta.


Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Veias/anormalidades , Canal Inguinal/irrigação sanguínea , Testículo/irrigação sanguínea , Varicocele/etiologia , Veia Cava Inferior/anormalidades , Gônadas/irrigação sanguínea , Hérnia Inguinal/etiologia
11.
World J Pediatr Congenit Heart Surg ; 10(3): 330-337, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084312

RESUMO

BACKGROUND: Patients with heterotaxy, single ventricle and interrupted inferior vena cava are at risk of developing significant pulmonary arteriovenous malformations and cyanosis, and inequitable distribution of hepatic factor has been implicated in their development. We describe our experience with a technique for hepatic vein incorporation that reliably provides resolution of cyanosis and presumably equitable hepatic factor distribution. METHODS: A retrospective review of a single-surgeon experience was conducted for patients who underwent this modified Fontan operation utilizing an extracardiac conduit from the hepatic veins to the dominant superior cavopulmonary connection. Preoperative characteristics and imaging, operative details, and postoperative course and imaging were abstracted. RESULTS: Median age at operation was 5 years (2-10 years) and median weight was 19.6 kg (11.8-23 kg). Sixty percent (3/5) of patients had Fontan completion without cardiopulmonary bypass, and follow-up was complete at a median of 14 months (range 1-20 months). Systemic saturations increased significantly from 81% ± 1.9% preoperatively to 95% ± 3.5% postoperatively, P = .0008. Median length of stay was 10 days (range: 7-14 days). No deaths occurred. One patient required reoperation for bleeding and one was readmitted for pleural effusion. Postoperative imaging suggested distribution of hepatic factor to all lung segments with improved pulmonary arteriovenous malformation burden. CONCLUSIONS: Hepatic vein incorporation for patients with heterotaxy and interrupted inferior vena cava should optimally provide equitable pulmonary distribution of hepatic factor with resolution of cyanosis. The described technique is performed through a conventional approach, is facile, and improves cyanosis in these complex patients.


Assuntos
Anormalidades Múltiplas , Malformações Arteriovenosas/cirurgia , Veia Ázigos/cirurgia , Técnica de Fontan/métodos , Veias Hepáticas/cirurgia , Síndrome de Heterotaxia/cirurgia , Veia Cava Inferior/cirurgia , Veia Ázigos/anormalidades , Criança , Pré-Escolar , Feminino , Veias Hepáticas/anormalidades , Humanos , Masculino , Estudos Retrospectivos , Veia Cava Inferior/anormalidades
12.
Exp Anim ; 68(4): 465-470, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31142684

RESUMO

The formation of the caudal vena cava is a complex process involving development, regression, and anastomosis. In mammals, the normal caudal vena cava runs to the right side of the abdominal aorta, while duplication of the caudal vena cava has been identified as a congenital abnormality in both companion animals and humans. The present study demonstrates that Slc:Hartley guinea pigs frequently possess asymptomatic duplicated caudal vena cava. The prevalence was 30% and 24% for males and females, respectively, with no sex-related differences. In accordance with Saad et al. (2012)'s criteria, duplicated caudal vena cava were classified into two distinct variations. The dominant variation was a complete duplication without iliac anastomosis where the left caudal vena cava continued from the left common iliac vein and joined the left renal vein; the left renal vein ran to the right to join the right caudal vena cava. The alternative variation was an incomplete duplication where the left caudal vena cava joined the right infrarenal caudal vena cava at a more cranial point than in normal cases; the renal segment was unchanged. Iliac anastomosis was not found in any cases. Duplicated caudal vena cava neither affected the body weight nor the kidney weight. In conclusion, Slc:Hartley guinea pigs frequently possess asymptomatic duplicated caudal vena cava in the absence of iliac anastomosis and appear to be a novel and useful animal model for duplicated caudal vena cava in animals and humans.


Assuntos
Cobaias/anormalidades , Veia Cava Inferior/anormalidades , Animais , Feminino , Cobaias/anatomia & histologia , Veia Ilíaca/anormalidades , Veia Ilíaca/anatomia & histologia , Masculino , Veias Renais/anormalidades , Veias Renais/anatomia & histologia , Veia Cava Inferior/anatomia & histologia
13.
BMJ Case Rep ; 12(5)2019 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-31129644

RESUMO

Malformations of inferior vena cava (IVC) as agenesis are a rare congenital anomaly and cause of deep venous thrombosis (DVT) of lower limbs and should be investigated in young patients of unknown aetiology. Treatment with mechanical thrombectomy and thrombolysis can be considered in certain cases of DVT, promoting rapid clot removal, and has also been shown to be an effective treatment in acute DVT. We present a case of acute lower limb DVT associated with IVC agenesis in which Alteplase thrombolysis was used and thrombus aspiration with catheter bilaterally, with subsequent angioplasty of the common and external iliac, obtaining satisfactory results.


Assuntos
Trombectomia/métodos , Terapia Trombolítica/métodos , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/cirurgia , Doença Aguda , Adulto , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Flebografia , Resultado do Tratamento , Ultrassonografia Doppler , Veia Cava Inferior/anormalidades , Trombose Venosa/diagnóstico por imagem
16.
Tex Heart Inst J ; 46(1): 36-40, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30833836

RESUMO

Infrarenal abdominal aortic aneurysm with aortocaval fistula, a rare condition, can be fatal without prompt intervention. The clinical symptoms are complex and varied, so diagnosis is typically confirmed by use of contrast-enhanced multidetector computed tomography. We report our surgical repair of a 13-cm-diameter infrarenal abdominal aortic aneurysm and aortocaval fistula in a 63-year-old orchestral tuba player who had 2 classic symptoms of the condition. The unruptured aneurysm and fistula were complicated by acutely angled vessels, so we performed surgery rather than endovascular repair. The patient recovered fully and was discharged from the hospital. This infrarenal aneurysm with aortocaval fistula is perhaps the largest to have been treated successfully by means of open surgery. In addition to our patient's case, we discuss the history and treatment considerations of this rare combined condition.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Fístula Arteriovenosa/cirurgia , Implante de Prótese Vascular/métodos , Procedimentos Endovasculares/métodos , Veia Cava Inferior/cirurgia , Aorta Abdominal/anormalidades , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico , Aortografia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Música , Flebografia , Veia Cava Inferior/anormalidades
18.
BMC Pulm Med ; 19(1): 49, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30795758

RESUMO

BACKGROUND: The term hepatopulmonary syndrome typically applies to cyanosis that results from "intrapulmonary vascular dilatation" due to advanced liver disease. Similar findings may result from a congenital portosystemic shunt without liver disease. An adverse consequence of such shunts is intrapulmonary vascular dilatation, which affects the microvascular gas exchange units for oxygen. CASE PRESENTATION: Here, we describe a toddler with chronic cyanosis, exercise intolerance, and finger clubbing due to a malformation shunt between the portal vein and the inferior vena cava. A transcatheter embolization of the shunt resulted in resolution of his findings. CONCLUSIONS: Congenital portosystemic shunts need to be considered in the differential diagnosis of cyanosis.


Assuntos
Cianose/etiologia , Osteoartropatia Hipertrófica Secundária/etiologia , Veia Porta/anormalidades , Malformações Vasculares/complicações , Veia Cava Inferior/anormalidades , Angiografia , Pré-Escolar , Dilatação Patológica/diagnóstico por imagem , Ecocardiografia , Embolização Terapêutica , Humanos , Masculino , Veia Porta/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/terapia , Veia Cava Inferior/diagnóstico por imagem
19.
J Card Surg ; 34(3): 139-142, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30702184

RESUMO

Pulmonary arteriovenous malformation is an important complication after Fontan completion in patients with univentricular circulation. Lack of hepatic venous flow in a pulmonary artery has been identified as a cause of pulmonary arteriovenous malformation. We report our experience with a case of redirection of the hepatic vein to the hemiazygos vein using a conduit via left thoracotomy and median sternotomy for the correction of unequal distribution of hepatic venous flow in the pulmonary arteries. The pulmonary arteriovenous malformation improved, leading to increased arterial saturation levels.


Assuntos
Malformações Arteriovenosas/etiologia , Veia Ázigos/anormalidades , Veia Ázigos/cirurgia , Técnica de Fontan , Veias Hepáticas/cirurgia , Complicações Pós-Operatórias/etiologia , Artéria Pulmonar/anormalidades , Veias Pulmonares/anormalidades , Procedimentos Cirúrgicos Vasculares/métodos , Veia Cava Inferior/anormalidades , Malformações Arteriovenosas/cirurgia , Criança , Feminino , Humanos , Fígado/irrigação sanguínea , Fluxo Sanguíneo Regional , Esternotomia/métodos , Toracotomia/métodos , Resultado do Tratamento
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