Part Of Superior Vena Cava Research Articles

Superior Vena Cava Resection in Locally Advanced Thymoma-Surgical and Survival Outcomes.

This study was aimed at reporting the surgical management of superior vena cava invasion in patients with locally advanced thymoma and to evaluate surgical and survival outcomes. This is a retrospective analysis of 12 patients operated for superior vena cava resection for locally advanced thymoma over 8years in a thoracic surgery centre in India. An analysis of peri-operative variables including complications was carried out. The influence of various predictors on survival was assessed by log-rank test. Intra-operatively, superior vena cava (SVC) alone was involved in 3 (25%) cases, SVC with BCV involvement was there in 8 cases (66.7%) and in 1 patient, the SVC involvement extended into the right atrium also. In all cases, the tumour was resected en bloc with the involved part of SVC. Repair with primary closure was sufficient in 2 cases (16.6%) in view of < 1/3rd of circumferential involvement. However, in remaining 10 cases, SVC was replaced with PTFE graft (single graft in 6 cases, Y-graft in 2 cases and twin grafts in 2 cases). No peri-operative deaths. Overall survival (OS) at 1, 3 and 5years was 100%, 91.6% and 83.3%, respectively. Myasthenia gravis and higher Masaoka stage (IV A) of the disease were poor predictors of survival. Superior vena cava resection and reconstruction is a feasible and oncologically superior option in invasive thymoma with SVC involvement. This challenging surgical procedure should only be attempted by an experienced team of thoracic and cardiac surgeons at high-volume centre to achieve best outcomes.

Late diagnosis of total anomalous pulmonary venous drainage in a 5.5-month-old infant.

A 5.5-month-old girl was admitted with non-specific signs and symptoms like dyspnea at rest, tachypnea, fatigue, low body weight and cyanosis on exertion. Physical examination revealed a barrel-shaped chest; no pathological sounds over the heart or both lung areas were detected. The above mentioned symptoms might suggest a circulatory problem. Echocardiography and computed tomography angiography were performed. These examinations revealed supracardiac type total anomalous pulmonary venous drainage. Echocardiographic signs of pulmonary hypertension and severe right ventricle overload were detected. Detailed analysis of both imaging examinations revealed atypical obstruction of the pulmonary venous return: narrowing of the proximal part of superior vena cava. An urgent surgery was performed, with no complications in the postoperative period. A follow-up echocardiography showed normalization of cardiac function and pulmonary pressure as well as normalization of flow profile within the superior vena cava. The paper presents a non-invasive diagnostic process in the described case, and discusses the causes of late diagnosis.

An 11-year retrospective study of totally implanted central venous access ports: Complications and patient satisfaction

Aims We wanted to assess the factors that predict complications and patient satisfaction of totally implanted central venous access ports (TIAP). Methods We reviewed 550 patients with breast or gynaecological malignancies who had initial port placement for chemotherapy between 1995 and 2006. We retrospectively assessed all TIAP complications, port duration and follow-up care until the TIAPs were removed (or the last known recorded documentation) or until the death of the patient. TIAP-related patient satisfaction was also assessed via a questionnaire-based survey of 356 patients. Results 561 TIAPs were placed in 550 cancer patients (11 patients received 2 TIAPs during the study period); the median time of port duration was 22.5 months. There were 104 complications in this group. Of these, 81 occurred during chemotherapy treatment that lasted a median time of 182 days. Removal secondary to complication was observed in 48 cases. TIAPs placed on the left chest side, through the subclavian vein or with the catheter tip localized in the peripheral part of superior vena cava demonstrated the highest incidence of complications. Patients with a BMI >28.75 had an increased risk for developing complications. Our follow-up questionnaire revealed a 93% patient satisfaction rate with the TIAP. Conclusions Patients with left-sided ports, catheter tips lying in the upper part of the superior vena cava and implantation via the subclavian vein are at a higher risk for TIAP-associated complications. Being excessively overweight was assessed as another risk factor for developing complications. TIAPs are highly accepted and further recommended by patients.

ORIGINATION AND TRANSMISSION OF IMPULSE IN THE RIGHT AURICLE.

(1) The origination and transmission of stimulus in right atrium of the canine or rabbit heart were studied by means of intracellular microelectrode method.(2) The area showing pacemaker potential pattern was localized in a area anterolaterally to the basal part of superior vena cava. The length was about 4.0mm and the breadth was also about 4.0mm. The true pacemaker potential pattern was obtained from slender zone within this area.(3) The spread of activation in this area was more or less radially in direction and almost constant in velocity except one direction along the zone toward crista terminalis showing true pacemaker potential. In this direction, the conduction rate was rather high and it was about 0.08M./sec.(4) After reaching crista terminalis, the activation was conducted with more accelerated velocity toward postero-inferior rand of the coronary sinus orifice and atrial septum through the right and septal branches of crista termi-nalis respectively. The conduction rate was about 1.5M./sec. which was the highest in the atrial musculature.(5) In the atrial free wall, the activation coming along through the crista terminalis was transmitted to mm. pectinati for farther conduction toward the A-V ring. The atrial roof musculature was activated by stimulus coming through a nearby m. pectinatus. The conduction rate through m. pectinatus was greater than that through atrial roof but was less than that through crista terminalis.(6) By cutting the crista terminalis or injecting osmic acid solution into this musculature, the stimulus conduction to distal portions of crista terminalis was markedly delayed. It was supposed that both branches of the crista termi-nalis played the most important role in stimulus conduction in the right atrium.(7) It was supposed that the musculature in the vicinity of the A-V node was activated by the stimulus coming along through 2 routes, one through the right branch and the other through the septal branch of the crista terminalis. At an area near the boundary of septal musculature and the A-V node, the conduction rate of activation wave showed marked decrease. A-V node was verified by its typical pattern of the membrane action potential.(8) The conduction rate of the activation wave in the area close to A-V ring became progressively decreased as the ring was approached and the activation was not transmitted beyond the ring. With this progressive de-crease in the conduction rate, the membrane action potential also gradually decreased in the steepness of the sharp depolarization upstroke. It was speculated that the changes in membrane action potential were an important cause for the constant blockade of stimulus conduction between atrial and ventricular musculature.