Drainage Of Superior Vena Cava Research Articles

Percutaneous superior vena cava drainage during minimally invasive mitral valve surgery: a randomized, crossover study.

Minimally invasive techniques commonly are applied to mitral valve surgery; however, there has been little research investigating the optimal methods of cardiopulmonary bypass for the right minithoracotomy approach. Controversy exists as to whether a percutaneous superior vena cava drainage cannula (PSVC) is necessary during these operations. The authors, therefore, sought to determine the effect of using a percutaneous superior vena cava catheter on brain near-infrared spectroscopy, blood lactate levels, hemodynamics and surgical parameters. Randomized, blinded, crossover trial. Tertiary care university hospital. Patients undergoing minimally invasive mitral valve surgery via a right minithoracotomy. Twenty minutes of either clamped or unclamped percutaneous superior vena cava neck catheter drainage, during mitral valve repair. For the primary outcome of brain near-infrared spectroscopy, there were no differences between the two groups (percutaneous superior vena cava clamped 55.0%±11.6% versus unclamped 56.1%±10.2%) (p = 0.283). For the secondary outcomes pH (clamped 7.35±0.05 versus unclamped 7.37±0.05 p = 0.015), surgical score (clamped 1.96±1.14 versus unclamped 1.22±0.51 p = 0.002) and CVP (clamped 11.6 mmHg±4.8 mmHg versus unclamped 6.1 mmHg±6.1 mmHg p<0.001) were significantly different. The use of a percutaneous superior vena cava drainage improved surgical visualization and lowered CVP, but had no effect on brain near infrared spectroscopy during minimally invasive mitral valve surgery. (ClinicalTrials.gov Identifier: NCT01166841).

Bilateral superior vena cava with right superior vena cava draining into left atrium

Anomalies of systemic venous return are extremely heterogeneous congenital malformations with variable ranges from completely normal physiology to severe forms of right to left shunting requiring surgical treatment. Anomalous drainage of a right-sided superior vena cava (SVC) to the left atrium (LA) is one of the rarest variants of systemic venous return anomalies, characterized by right-to-left shunt physiology and cyanosis. Here we report a 2years old girl presented with cyanosis which was observed shortly after birth by her parents but not further investigated. She is otherwise active girl and with normal growth and development. Her clinical examination was unremarkable apart from mild clubbing of the fingers and low oxygen saturation of 88–90% in room air. Her ECG and chest X-ray were unremarkable. Echocardiography showed bilateral SVC connected by a small innominate vein. The right SVC drains directly into the LA while the left SVC drains into the right atrium (RA) via a dilated coronary sinus. There is a small superior sinus venosus type atrial septum defect (ASD) with left to right shunt. Also, there is partial anomalous pulmonary venous return with right upper and right middle pulmonary veins draining directly into the right SVC, which is connected to LA. The right lower pulmonary vein and left pulmonary veins drain directly to LA. The rest of her echocardiography demonstrated normal heart structures and function. This patient was referred for surgical correction, including baffling of the right SVC to the RA and closure of the ASD. We describe this case to highlight the importance of recognizing this rare anomalous systemic venous connection as one of the very rare causes of cyanosis in the pediatric age group as well as at older age.

Right Superior Vena Cava to Left Atrium: Importance of “Bubbling It Right”

Mini‐AbstractBubble contrast echocardiogram is conventionally done through left hand while evaluating patients with unexplained cyanosis. We hereby report a case of anomalous drainage of superior vena cava to left atrium in child and highlight the importance of doing bubble contrast echocardiogram through right hand.

Persistent Left Superior Vena Cava Draining into Left Atrium as a Cause of Persistent Systemic Desaturation after Surgery

Persistent left superior vena cava (LSVC) is a rare congenital anomaly which usually produces no physiologic derangements if it drains into the right atrium via the coronary sinus, but it may cause significant desaturation when it drains into the left atrium (LA). Failure to diagnose LSVC communicating with the LA preoperatively may lead to serious consequences. We are describing an interesting case of a boy who presented with systemic desaturation due to an undetected LSVC after having undergone corrective surgery for atrioventricular canal defect. We have demonstrated that echocardiography with agitated saline contrast is a simple, accurate, and inexpensive diagnostic modality.

Superior Vena Cava Drainage During Thoracoscopic Cardiac Surgery: Bilateral Internal Jugular Vein Sheaths Versus One Percutaneous Superior Vena Cava Cannula

To evaluate bilateral internal jugular vein sheaths as a replacement of one percutaneous superior vena cava cannula for superior vena cava drainage during thoracoscopic cardiac surgery. A prospective and randomized study. Single cardiovascular institute. Adults undergoing thoracoscopic cardiac surgery. Patients were randomized into a percutaneous superior vena cava cannula group and a bilateral internal jugular vein sheaths group. The superior vena cava drainage for cardiopulmonary bypass was performed with one percutaneous superior vena cava cannula (14-18 Fr) or the bilateral internal jugular vein sheaths (8 Fr). Both interventions reached theoretic flow rate in all patients. In patients weighing<50 kg (n=38) and 50-70 kg (n=64), the average central venous pressure values during cardiopulmonary bypass of both groups showed no significant differences. The patients weighing>70 kg (n=15) in the bilateral internal jugular vein sheaths group had a normal average central venous pressure value, but it was significantly higher than that of percutaneous superior vena cava cannula group ([10.5±3.1] mmHg vs. [4.5±4.4] mmHg, p=0.013). The patient satisfaction scale scores for the cervical incisions were significantly higher in the bilateral internal jugular vein sheaths group than in the percutaneous superior vena cava cannula group ([2.6±0.9] vs. [2.1±0.8], p=0.002). The bilateral internal jugular vein sheaths were a feasible and effective option to replace one percutaneous superior vena cava cannula during thoracoscopic cardiac surgery, with better patient satisfaction.

Perkütan internal jugüler ven kanülasyonu ile kalp cerrahisi

Background: In this study, we evaluated the use of percutaneous internal jugular vein cannulation for open cardiac surgeries and reported our experience on the cannulation and the procedure. Methods: Between February 2010 and October 2012, 42 patients (23 males, 19 females; mean age 45±21.9 years; range 2-82 years) who were operated through percutaneous internal jugular vein cannulation were retrospectively analyzed. An Edwards® Fem- Flex II percutaneous femoral artery cannula which was designed for arterial procedures was used. Cannulation was performed percutaneously with the Seldinger technique. Sixteen Fr cannulas were used for adults with a body surface area less than 1.7 m2, while 18 Fr cannulas were used for patients adults with a body surface area above 1.7 m2. Minimally invasive cardiac surgery was performed on 25 patients, whereas redo operations were required in 17 patients. Central venous pressure was recorded by cannulae which were advanced through the left internal jugular vein to monitor the adequacy of superior vena cava drainage. Results: No hospital mortality was observed in the study group. Internal jugular venous cannulation was accomplished without a major percutaneous complication in all patients. An additional atrial cannula was inserted following median sternotomy due to displacement of the femoral venous cannula in three patients. There was no significant difference in central vein pressure and vacuum use among the adult patients who were inserted 16 and 18 Fr cannulas. Conclusion: The use of femoral artery cannulas for percutaneous internal jugular vein cannulation is technically easy and can be performed with no serious complications. It also offers adequate superior vena cava drainage and facilitates procedures which require opening of right-sided cardiac structures with peripheral vascular cannulas.

Raghib’s syndrome with the absence of the right superior vena cava

A 40-year-old female diagnosed with a 42 mm atrial septal defect (ASD) (Figure 1a), drainage of the persistent left superior vena cava (PLSVC) into the left atrium (Figure 1b), and an absence of both the coronary sinus (Figure 2a) and right SVC (Figure 2b) was referred to our department. Cardiac catheterization showed the persistent drainage of the LSVC into the left atrium. During the catheterization, the mean pulmonary artery pressure (PAP) was 22 mmHg, and the volume of pulmonary flow (Qp) / the volume of systemic flow (Qs) was 1.5. The patient then underwent cardiac surgery. Arterial cannulation was performed from the ascending aorta and venous cannulation was carried out from the PLSVC and inferior vena cava (IVA). Under cardiopulmonary bypass (CPB), the ASD was closed with a pericardial patch, and the PLSVC was separated from the left atrium and anastomosed to the left pulmonary artery (LPA). The patient’s postoperative course was uneventful. Five years have passed since the surgery, and she has no upper extremity or facial edema. Furthermore, the most recent control computed tomography (CT) angiography showed patent anastomosis (Figure 2b). In addition, control echocardiography detected a systolic PAP of 22 mmHg and clearly indicated an intact interatrial septum with drainage from the PLSVC into the LPA.

Percutaneous Superior Vena Cava Drainage Improves Outcomes During Minimally Invasive Mitral Valve Surgery: a Randomized, Cross-Over Study

Minimally invasive mitral valve surgery relies upon optimal venous drainage and perfusion strategies to prevent cardiac distension and allow adequate perfusion. Controversy exists as to whether a percutaneous superior vena cava drainage cannulae (PSVC) is necessary during these operations. We therefore sought to determine the effect of using a PSVC on brain near infrared spectroscopy (BNIRS), blood lactate levels, as well as hemodynamic and surgical parameters.

Chronic Cyanosis Due to Persistent Left Superior Vena Cava Draining into the Left Atrium in the Absence of a Coronary Sinus

We report a rare case of a 5-year-old child who presented with chronic hypoxemia and a normal cardiac examination, and was found to have a persistent left superior vena cava draining directly into the left atrium. The coronary sinus was absent. This case introduces a contradiction to the generally accepted concept that this anomalous connection can only occur in the presence of a partly or completely unroofed coronary sinus. High index of suspicion is required to include this pathology in the differential diagnosis for a patient with persistent cyanosis with normal cardiac examination.

Transcatheter Treatment of Patent Foramen Ovale Combined with Abnormal Drainage of Left Superior Vena Cava to Left Upper Pulmonary Vein

Patent foramen ovale (PFO) has been known to be the cause of transient ischemic attacks or stroke, and transcatheter device closure has been the treatment of choice for these defects. Combined defect of abnormal drainage of left superior vena cava (LSVC) to left superior pulmonary vein (LSPV) in PFO patients is an uncommon combination, and both can act as a pathway for paradoxical embolism. We report a successful closure of PFO, using Amplatzer® PFO occluder (St. Jude Medical, St. Paul, MN, USA) and persistent LSVC connected to LSPV using an Amplatzer® Vascular Plug II (St. Jude Medical, St. Paul, MN, USA). Because this combined anomaly of PFO and persistent LSVC can be treated by a single transcatheter intervention, if clinically suspected, a complete evaluation for this anomaly should be considered.

Right superior vena cava draining in the left atrium associated with tetralogy of Fallot and pulmonary atresia

We report a case of an anomalous drainage of the right superior vena cava to the left atrium with intact atrial septum associated with Tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries.

Isolated Right Superior Vena Cava Draining into the Left Atrium

A 10-year-old male was admitted to our institution with complaints of mild cyanosis and dyspnea. Transthoracic echocardiography and angiography revealed a right superior vena cava (SVC) draining into the left atrium. At the time of surgery, the right SVC was connected to the right atrium.

Right superior vena cava drainage into the left atrium revealed by multiples strokes after pacemaker implantation

An 84-year-old woman had undergone dual-chamber pacemaker implantation in a primary care hospital for sick sinus syndrome. The leads were inserted through the right subclavian vein because the patient was left-handed. One year later, she suffered from an ischemic stroke. During ventricular pacing, ECG showed a right bundle branch block pattern, and chest radiography (Figure 1A) suggested that pacing lead tips were in the left atrium (LA) and left ventricle. After transthoracic and transesophageal echocardiography, it was initially thought that the leads passed through a patent foramen ovale.

An Anomalous Left Superior Venacava Draining into Left Atrium in association with Fetal Valproate Syndrome

Prenatal exposure of mother to valproic acid causes teratogenic effects on fetus. The authors report an 18 h-old girl with typical facial and limbs features of fetal valproate syndrome (FVS) along with abnormal draining of left superior vena cava into left atrium.

Radio-anatomy of the superior vena cava syndrome and therapeutic orientations

Superior vena cava syndrome (SVCS) groups all the signs secondary to the obstruction of superior vena cava drainage and the increase in the venous pressure in the territories upstream. There are two major causes of SVCS: malignant, dominated by bronchopulmonary cancer, and benign, often secondary to the presence of poorly positioned implantable venous devices. CT scan is the key examination for the exploration of SVCS. It specifies the characteristics of the stenosis, its aetiology and detects collateral venous routes. Scannography reconstructions provide a true map of the obstacle, indispensable in planning the endovascular treatment.

Left Hepatic Vein and Persistent Left Superior Vena Cava Drainage into the Coronary Sinus with Subaortic Valve Stenosis

Persistent left superior vena cava (PLSVC) and left hepatic vein drainage into the coronary sinus is a very rare combination of thoracic venous anomalies. A literature search revealed only two previously reported cases. PLSVC is associated with congenital heart disease and impulse conduction abnormalities. Subaortic valve stenosis is among these abnormalities. We present an extremely rare case of a 19-year-old woman who presented with PLSVC and left hepatic vein drainage into the coronary sinus associated with subaortic valve stenosis. The vascular anomalies were noted on a computed tomography angiogram of the chest performed for a history of shortness of breath. The patient had been previously diagnosed with and underwent treatment for subaortic valve stenosis at ages 2 and 8. PLSVC increases the incidence of congenital heart disease.

Cor Triatriatum with Tetralogy of Fallot and Anomalous Drainage of Left Superior Vena Cava: A Case Report and Literature Review

Cor triatriatum is a rare malformation, especially in association with tetralogy of Fallot, and has only been reported a few times in the literature. Due to the complexity of this abnormality, careful intraoperative exploration and a good differential diagnosis are crucial to select the appropriate surgical procedure. Here, we report a case with this rare combination of anomalies, an abnormal membranous septum above the mitral valve, and anomalous drainage of the left superior vena cava. The patient was successfully treated and achieved excellent hemodynamic parameters.

Diagnosis of Inadvertent Cannulation of the Azygos Vein During Cardiopulmonary Bypass

Cardiac surgery with cardiopulmonary bypass demands diligence and attention to detail to prevent neurologic injury. Arterial and venous cannulae are used to facilitate cardiopulmonary bypass. The assessment of adequate decompression of the venous circulation is an essential duty of the cardiac surgical team. Modalities for the assessment of adequate regional venous drainage are limited, however communication between the team and increased awareness of certain pathologic states can be useful. These modalities include cerebral oximetry and superior vena caval pressure monitoring, which were employed during a case with bicaval venous cannulation. Malposition of the superior vena cava cannula was detected after a series of events alerted the team that superior vena cava drainage may be compromised.

Surgical repair for anomalous drainage of left superior vena cava to left atrium

To investigate the characters and surgical treatment methods of anomalous drainage of left superior vena cava to left atrium. Clinical data of 8 cases were analyzed retrospectively.The patients aged from 6 months to 168 months with weight between 6 and 29 kg. The associated cardic lesions existed in all patients: 4 had partial atrioventricular septal defect (PAVSD),including 1 coronary sinus orifice atresia (CSOA), 1 ventricle septal defect (VSD), 1 ventricle septal defect associated with right ventricular outlet tract stenosis (VSD/RVOTS), and 1 atrial septal defect (ASD) and complete atrioventricular septal defect (CAVSD), respectively.No patient died. Preoperation diagnosis was in 1 case, intraoperation diagnosis in 5 cases,and postoperation diagnosis in 2 cases due to reoperation for hypoxemia.Three patients were repaired by intratrium tunnel, and the other 5 were managed by extracardic shunt. This lesion is easily missed in preoperation diagnosis,which can be avoided by awareness and careful inspection.The methods for management of anomalous drainage of left superior vena cava to left atrium depend on time of diagnosis and experience of surgeons.

Multimodality Noninvasive Imaging for Assessment of Congenital Heart Disease

Major advances in the field of pediatric cardiology and cardiac surgery over the last several decades have led to a dramatic improvement in survival rates for most forms of congenital heart disease (CHD). For example, hypoplastic left heart syndrome, a previously lethal defect, now has early survival rates up to 90% at major centers.1 These improved outcomes have produced a growing population of survivors with complex CHD who are now reaching adulthood (Figure 1). During this period, improvements in surgical and medical treatments have been accompanied by developments in diagnostic modalities. Echocardiography has replaced catheterization as the primary diagnostic modality, and it is now uncommon for newborn infants to undergo catheterization for purely diagnostic purposes. Although echocardiography remains the bedrock of noninvasive cardiac imaging, the array of diagnostic modalities and techniques available continue to grow and this has spawned the specialty of “noninvasive cardiac imaging” and the need for the “cardiac imager” to be adept in all the different modalities. Figure 1. Percentage of patients under the age of 1 year (grey bars) and over the age of 18 years (black bars) undergoing echocardiography at Children’s Hospital Boston from 1983 through 2006. Note the reverse trends of these age groups reflecting the steady increase in the proportion of adult patients with congenital heart disease. Although the absolute number of infants undergoing echocardiography during this time period has increased, their proportion has steadily declined. Echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) are the primary modalities used for noninvasive cardiac imaging in patients with CHD. Nuclear scintigraphy is used in selected circumstances. The Table summarizes the strengths and weaknesses of each modality. Figure 2 shows temporal trends in utilization for the various noninvasive cardiac imaging techniques at our center. It is clear that echocardiography is the most frequently …