Retroaortic Innominate Vein Research Articles

Ascending Sliding Arch Aortoplasty for Coarctation of the Aorta and Hypoplastic Aortic Arch to Avoid Compression of a Retroaortic Innominate Vein.

The retroaortic innominate vein variant usually courses asymptomatically. However, when associated with coarctation of the aorta and hypoplastic aortic arch, modifications in the surgical technique to correct the aorta should be done to avoid compression of the vein. The ascending sliding arch aortoplasty, which allows the vein to be brought anterior to the aorta, can be a good alternative, as shown in these two cases.

Fetal echocardiographic diagnosis of a triad with common embryological origins: Cervical aortic arch, retro‐aortic left innominate vein and coarctation of the aorta

Cervical aortic arch (CAA) and retro-aortic innominate vein (RAIV) are rare entities which can be associated with one another in a structurally normal heart. Less well recognized is the fact, that a third entity may often be present as well, since aortic arch abnormalities are common in a CAA. Hence, these three entities (CAA, RAIV, and an arch anomaly - in this case a post-ductal coarctation) may present as a triad. We present the first prenatal diagnosis of this rare triad which can be explained by common embryological origins which are discussed along with instructive aspects in diagnosis and management.

Prenatal diagnosis of isolated retroaortic left innominate vein with a left aortic arch

Prenatal diagnosis of isolated retroaortic left innominate vein with a left aortic arch

Repair technique for a rare partial anomalous pulmonary venous return associated with retroaortic innominate vein

BackgroundRetroaortic innominate vein (RIV) is a rare vascular abnormality. Although RIV itself is asymptomatic, its presence in patients with partial anomalous pulmonary venous return (PAPVR) to the superior vena cava (SVC) is surgically challenging because a simple Warden procedure is impossible.Case presentationA 16-year-old girl was diagnosed with tetralogy of Fallot, secundum, and sinus venosus atrial septal defect (ASD) at birth. She underwent total correction of tetralogy of Fallot and ASD closure at the age of 14-months. However, the diagnosis of PAPVR was missed. At the age of 16, she developed dyspnea on exercise. Echocardiography demonstrated severe pulmonary regurgitation, mild tricuspid regurgitation, and D-shaped left ventricle with paradoxical septal motion along with RIV and sinus venous ASD. Computed tomography confirmed RIV and PAPVR. Systemic and pulmonary venous blood pathways were separated by bovine pericardial patch, and pulmonary valve replacement was performed. Postoperative echocardiography demonstrated improvement of D-shaped left ventricle and laminar flow through the SVC and pulmonary veins. Postoperative computed tomography showed a well-reconstructed SVC and pulmonary venous pathway without stenosis. After an uneventful postoperative course, patient was discharged.ConclusionsPAPVR in patients with RIV may be surgically challenging to repair. We report the first case of successfully repaired PAPVR associated with RIV.

Incidental retroaortic innominate vein in a patient with acute aortic dissection

BackgroundRetroaortic innominate vein is a rare anomaly. It has been reported in patients with congenital anomalies such as Tetralogy of Fallot or right aortic arch. However, isolated retroaortic innominate vein is quite rare.Case presentationA 63-year-old man was transferred to our institution because of Stanford type A acute aortic dissection. Incidentally, we noticed that the left innominate vein coursed under the aortic arch and was directed into the superior vena cava on computed tomography. We performed emergent hemiarch replacement.ConclusionsAttention must be paid to the cannulation site for venous uptake and the method of myocardial protection.

Rare Outcome of Lecompte’s Maneuver: SVC Compression due to Retro Aortic Innominate Vein

The impact of Lecompte’s maneuver on superior vena cava (SVC) has never been mentioned before. We think that in certain anatomical subsets, Lecompte’s maneuver can result in superior vena cava narrowing. We present a case report of patient with Tetralogy of Fallot with absent pulmonary valve with retro-aortic innominate vein who developed SVC thrombosis after Lecompte’s maneuver.

Clinical significance of prenatal ultrasonography in diagnosis of fetal retroaortic left innominate vein

Objective To evaluate the clinical significance of prenatal ultrasonography in diagnosis of retroaortic left innominate vein(LINV). Methods Thirty fetus with retroaortic LINV were involved,including 17 cases of isolated retroaortic LINV and 13 cases of complicated retroaortic LINV. Three-vessel and trachea (3VT) view was focused in the routine second trimester ultrasound screening to observe whether LINV existing or not. And then the transducer was rotated to the fetal sagittal view to assess the relationship between LINV and aortic arch and the convergence of left subclavian vein and left internal jugular vein into the LINV. Results The characteristic feature of retroaortic LINV was the LINV converge into right superior vena cava (SVC) under the aortic arch,not above the aortic arch. The most important plane to detect the retroaortic LINV was the 3VT view,which revealed the abnormal vein lying to the left of pulmonary artery. The abnormal vein then could be traced and revealed its connection with the right SVC beneath the aortic arch on the transverse plane inferior to the 3VT view and on the fetal sagittal plane. Conclusions The whole course of retroaortic LINV can be revealed by ultrasound prenatally,which can not only account for the abnormal vein to the left of pulmonary artery on 3VT view,but also play an important role in surgery decision and future cardiac intervention treatment. Key words: Echocardiography; Fetus; Heart defects,congenital; Retroaortic left innominate vein

A case of pacemaker implantation in the patient with duplication of the left innominate vein: a case report.

Introduction Duplication of the left innominate vein is a rare systemic venous anomaly defined as the coexistence of a retroaortic innominate vein and a normally positioned left innominate vein. We describe a successful case of pacemaker implantation in a patient with duplication of the left innominate vein via a retroaortic innominate vein.Case descriptionA 70-year-old mentally challenged man was admitted to our hospital because of bradycardia and an altered state of consciousness. Electrocardiogram indicated sinus arrest and junctional escape rhythm with a heart rate of 40 beats/min; hence, a pacemaker was implanted. Left subclavian venography showed two vessels that were connected to the superior vena cava: a narrow, normal positioned left innominate vein and a tortuous vein. The normally positioned left innominate vein was too narrow to pass through with a guide wire. Therefore, we chose the tortuous vein for implantation. However, the procedure was difficult because of the vein’s tortuosity. Finally, leads at the right atrium and ventricle were successfully implanted using a steerable stylet. After the procedure, computed tomography showed two innominate veins: a retroaortic innominate vein and narrow left innominate vein that was a duplication of the left innominate vein.Discussion and evaluationThe exact embryogenesis of retroaortic innominate vein remains unknown and incidence of retroaortic innominate vein is very rare. But for cardiologists performing transvenous pacemaker insertion, the anomalous brachiocephalic vein may cause technical difficulty during a left arm approach.ConclusionsIn cases in which subclavian venography shows a tortuous vein, cardiologists should consider the presence of a retroaortic innominate vein.

Truncus arteriosus, tricuspid atresia and partial anomalous pulmonary venous drainage: a unique form of univentricular heart.

We present the first reported case of truncus arteriosus, tricuspid atresia and partial anomalous pulmonary venous drainage into a retro-aortic innominate vein in a neonate in whom successful palliation was performed using a two-staged procedure. An early repair after presentation along with a re-routing of anomalous pulmonary venous drainage at the time of the second stage should be undertaken to optimize the patient's haemodynamic status prior to a Fontan completion.

Isolated retroaortic left innominate vein in an adult without cardiac or aortic anomalies

Retroaortic innominate vein is an uncommon variant reported in patients with congenital heart disease. However, isolated retroaortic innominate vein without associated cardiac or arch anomalies is extremely rare. We present a case of a 68-year-old man who was found to have this anomalous variant incidentally on computed tomography (CT) of the thorax. We also briefly discuss its associations, embryology, and clinical significance.

Systemic venous anomalies in the Middle East

Introduction: Systemic venous anomalies are quite rare and can be associated with congenital heart disease requiring surgery.Materials and Methods: All consecutive patients (pts) undergoing surgery for congenital heart defects were retrospectively analyzed for presence of systemic venous anomalies: (a) Persistent left superior vena cava (PLSVC)(b) Inferior vena cava (IVC) interruption(c) Retro-aortic innominate veinResults: From 9/2010 to 5/2012 155 pts, median age 7 months, mean age 1.3 years (3 days–50 years), median weight 4 kg, mean weight 7.2 kg (0.6–110 kg) underwent congenital heart surgery. Twenty-nine systemic venous anomalies were identified in 28/155 patients (=18.1%). PLSVC was present in 21 pts (=13.5%), median age 4 months, mean age 2.7 years (3 days–22 years), median weight 6 kg, mean weight 10.1 kg (2.4–43.0 kg). IVC interruption was identified in 5 pts (=3.2%), median age 2 months, mean age 5.4 years (30 days–26 years), median weight 3.7 kg, median weight 17 kg (2.3–68.0 kg). Retro-aortic innominate vein was diagnosed in 3 pts (=1.9%), median age 5 years, mean age 3.7 years (10 months–5 years), median weight 12 kg, mean weight 10.1 kg (4.5–14 kg). Complete pre-operative diagnosis was obtained in 14/28 (=50%) pts with echocardiography and in other 8/28 (=28.6%) only after computed tomography (CT) scan, for a total of 22/28 (=78.6%) correct pre-operative diagnosis. In 6/28 (=21.4%) patients the diagnosis was intra-operative. Total incidence of systemic venous anomalies was 18.1% (vs. 4% in the literature, P = 0.0009), with presence of PLSVC = 13.5% (vs. 0.3–4.0%, respectively P = 0.0004 and P = 0.0012), IVC interruption = 3.2% (vs. 0.1–1.3%, N.S.), and retro-aortic innominate vein = 1.9% (vs. 0.2–1%, N.S.).Conclusions: Our study showed an incidence of systemic venous anomalies in Middle Eastern pts with congenital heart defects higher than previously reported. In 78.6% of pts the diagnosis was correctly made before surgery (echocardiography or CT scan), with 21.4% of complete diagnosis made at surgery. A careful pre-operative screening should be performed in all pts with congenital heart defects from this region to better identify all systemic venous anomalies for a more accurate surgical planning.

Differential diagnosis of vascular structures in relation to upper ascending aorta: The retro-aortic innominate vein

The retroaortic course of left innominate vein is a rare entity which can be misinterpreted during echocardiography for other abnormal vascular structures under the arch of aorta. We report the case of a 2 month old infant where the suprasternal window showed 2 vascular structures beneath the aortic arch, one of which was traced to be a retroaortic innominate vein.

Reconstruction of nonconfluent pulmonary artery using the retroaortic innominate vein for a single ventricle

The innominate vein usually courses anterior to the aortic arch, where it joins the right brachiocephalic vein to form the superior caval vein. A retroaortic innominate vein is an uncommon finding in patients with congenital heart disease. We report a patient with a single ventricle, single atrium, pulmonary atresia, nonconfluent pulmonary artery, persistent left superior caval vein, absent inferior caval vein (azygos connection), right aortic arch, and retroaortic innominate vein. His innominate vein took an anomalous course. The right brachiocephalic vein crossed from right to left underneath the aortic arch and formed a left superior caval vein with the left brachiocephalic vein and the azygos vein. We reconstructed the nonconfluent pulmonary artery using the retroaortic innominate vein and then performed a total cavopulmonary shunt when he was 32 months of age. Thereafter, a total cavopulmonary connection was carried out at age 42 months.

Unusual Cardiac Associations with Tetralogy of Fallot—A Descriptive Study

We present a large single-center series (>2200 cases) operated for Tetralogy of Fallot (TOF). We analyzed the incidence of associated unusual and uncommonly described cardiac lesions and their diagnostic and therapeutic implications in TOF patients. This retrospective study was conducted by reviewing records of patients operated for TOF at a large tertiary care pediatric cardiac centre. From 2002 to 2008, a total of 2235 cases of TOF were evaluated with echocardiography, cardiac catheterization, and/or cardiac computed tomography followed by cardiac surgery. Known and well-described associations were excluded from the study. Unusual associations were tabulated. Several unusual associations having an incidence >0.1% were detected. These included subaortic membrane (1%), pulmonary venous abnormalities (0.5%), small left ventricle (0.5%), interrupted inferior vena cava (0.5%), mitral valve abnormalities (0.4%), hemitruncus (0.4%), tricuspid valve abnormalities (0.4%), biventricular dysfunction (0.3%), retroaortic innominate vein (0.3%), bicuspid aortic valve (0.2%), and pericardial effusion (0.2%). This series describes unusual, not previously routinely reported cardiac lesions associated with TOF that may affect management and should be sought on preoperative evaluation. We demonstrate that more unusual associations do exist in not infrequent numbers, i.e., a TET is not just a TET.

Congenital Communication of a Retroaortic Innominate Vein with Both the Left and Right Atria in the Presence of a Normal Coronary Sinus

We report the first known case of a retro-aortic innominate vein providing continuity between both the left and right atria in the presence of a left superior vena cava and a normal coronary sinus. This unusual structure created a bidirectional shunt with clinical desaturation at baseline and it complicated the management of a 9-year-old patient while undergoing mechanical ventilation. An embryologic mechanism that explains the development of this complex remains elusive.

Retroaortic left innominate vein - Incidence, association with congenital heart defects, embryology, and clinical significance

In a retrospective analysis of echocardiograms, the incidence of retroaortic innominate vein was found to be 0.55% amongst children with congenital heart disease. It was most commonly associated with tetralogy of Fallot and right aortic arch.

Neonatal repair of right interrupted aortic arch, aberrant left subclavian artery, ventricular septal defect and retroaortic innominate vein

We report a rare case of neonatal biventricular repair of a right interrupted aortic arch (type B), with an aberrant left subclavian artery, ventricular septal defect and retroaortic innominate vein in a 4-week-old, 2.7 kg neonate with DiGeorge syndrome. The patient had an unremarkable postoperative recovery. We discuss the anatomy of this rare congenital anomaly, its surgical implications and issues surrounding the adequacy of the left ventricular outflow tract.

Novel use of a retroaortic innominate vein in cavopulmonary anastomosis

is well recognized. 3 We present a child with tricuspid atresia and pulmonary atresia with bifurcation stenosis of confluent pulmonary arteries (Figure 1). The child also had a right aortic arch. The parallel course of the retroaortic innominate vein with the pulmonary artery was used in pulmonary artery reconstruction by creating a wide side-to-side anastomosis (Figure 2). Clinical Summary The child was given a diagnosis of tricuspid atresia and pulmonary atresia at birth. He underwent placement of a left modified Blalock-Taussig shunt at day 1 of life. He was initially doing well, and then he presented at 6 months of life with increasing cyanosis. A central shunt from the aorta to the right pulmonary artery was placed through a sternotomy at another center. At 9 months of age, when he presented with increasing cyanosis, it was found that the central aortopulmonary shunt had become blocked and that there was narrowing of the left Blalock-Taussig shunt. A narrowed patent ductus was found supplying the right pulmonary artery. The patent ductus arteriosus (PDA) was stented, with the stent extending into the right pulmonary artery. When he presented to us at 1 year and 5 months of age, he had a patent but narrowed left Blalock-Taussig shunt, a blocked aortoright pulmonary shunt and a stented PDA supplying the right pulmonary artery, which had narrowed. He had an oxygen saturation of 72% on room air. There was severe stenosis of the pulmonary artery bifurcation at the site of PDA insertion (Figure 1). He had a right aortic arch. A computed tomographic angiogram revealed that he had a retroaortic innominate vein. A bidirectional Glenn procedure with pulmonary artery reconstruction was planned. After induction, a venous cannula in the left jugular vein was placed to detect any compression of the retroaortic innominate vein. The right and left jugular venous catheters showed equal pressures of 10 mm Hg. A redo median sternotomy was performed, and the aorta and right atrium were cannulated. All the systemic pulmonary shunts were controlled, and the patient was cooled to 18°C. The retroaortic innominate vein was dissected. It was found coursing just above the left pulmonary artery behind the PDA and inserting into the superior vena cava just above its junction with right atrium. The aorta was transected to provide unimpeded visualization of the pulmonary artery bifurcation. The pulmonary artery was opened, and the previous stent was removed piecemeal. The pulmonary artery was opened across the stenosed portion into the right and left pulmonary artery. The retroaortic innominate vein was opened parallel to the pulmonary artery from its insertion into the superior vena cava and anastamosed side to side, with the pulmonary artery providing a wide, unimpeded venous drainage into the pulmonary arteries and at the same time augmenting the stenosed portion of the pulmonary artery bifurcation (Figure 2). The aorta was reanastomosed, and the patient was weaned off cardiopulmonary bypass. The oxygen saturation was 87% with a fraction of inspired oxygen of 60%, and the left and

Retroaortic innominate vein with coarctation of the aorta: surgical repair and embryology review

A newborn girl with a retroaortic innominate vein, coarctation of the aorta, ventricular septal defect, and subaortic stenosis underwent a complete repair at 8 days of age. The ascending aorta was transected and the innominate vein was brought in front of it. We review the anatomy and embryology of this rare entity and describe the surgical technique to avoid recoarctation and innomante vein compression.

Tetralogy of Fallot, absent pulmonary valve, partial anomalous pulmonary venous return and coarctation of the aorta

We describe a unique combination of tetralogy of Fallot, absent pulmonary valve, aortic coarctation with partial anomalous pulmonary venous connection and a retroaortic innominate vein. Surgical repair was successfully accomplished in two stages: coarctation repair preceded correction of the intracardiac anomalies.