Vertical Vein Research Articles

Pulmonary-to-systemic venous collateral in obstructed supracardiac totally anomalous pulmonary venous connection: Blood finds a way!

We describe a rare variant of obstructed supracardiac totally anomalous venous connection in a 7-day-old boy where the vertical vein was occluded and the entire pulmonary venous return was draining through a large tortuous pulmonary-systemic venous collateral. The case highlights the importance of computed tomography angiography in demonstrating such complex anatomies in congenital heart diseases.

Non diagnosed PAPVC induce large reverse venovenous shunt after modified Fontan surgery: A case report of a rare anomaly and embolization therapy

Fontan operation is a reliable palliative surgery for patients with single ventricle physiology. Still, the development of complication is common; one of these complications that need to interventional approach is veno-venous collaterals between systemic and pulmonary veins. A 16-yearoldgirl with a history of modified Fontan operation at 9 years ago was referred with progressive cyanosis and dyspnea on exertion. In contrast trans-thoracic echocardiography (TTE), no fenestration was seen in Fontan circulation. Cardiac magnetic resonance revealed partial anomalous pulmonary vein connection (PAPVC) from left upper pulmonary vein to vertical vein and then into the in nominate vein and SVC with the reverse flow from superior vena cava (SVC) to left upper pulmonary vein(LUPV). This anomalous vein became severe engorged and tortuous. Possibly, LUPV and the verticalvein was dilated gradually as a result of increased pressure in the Fontan circuit. Finally, she underwent successful coil embolization in the midpart of the vertical vein. The oxygen saturation increased from80% to 93%.

Skempton’s poroelastic relaxation: The mechanism that accounts for the distribution of pore pressure and exhumation-related fractures in black shale of the Appalachian Basin

Middle and Upper Devonian gas shales of the Appalachian Basin host a sequence of mode I cracks from early veins to late unmineralized joints. These fractures develop during a cycle of burial and exhumation starting with horizontal veins, then vertical veins, then vertical joints, and ending with pancake joints. Veins are most common in the cross-fold orientation in gas shale of the deep hinterland, whereas joints are common in the shallow foreland fringe. Of particular interest for the recovery of natural gas are joints striking northeast to east-northeast in shallow core and outcrops of Appalachian gas shales, particularly in the underpressured, southwestern part of the basin. Northeast to east-northeast fractures are sparse in the deeper, northeastern part of the basin where the Marcellus gas shale is highly overpressured. The common occurrence of unmineralized joints in shallow gas shales is best explained with a stress–pressure–depth model for the evolution of pore pressure in the Appalachian Basin. Our model shows that by Skempton’s poroelastic relaxation, gas-charged porosity can drive natural hydraulic fractures during exhumation. In the shallow foreland fringe of the Appalachian Basin, exhumation was sufficient to favor the propagation of east-northeast–striking neotectonic joints in the contemporary tectonic stress field. These joints appear mainly at shallow depths where they facilitate leakage to form an underpressured gas column trapped by groundwater (i.e., Big Sandy gas field, Kentucky). Exhumation was insufficient for Skempton’s poroelastic relaxation to favor propagation of east-northeast joints in the deep, central part of the basin where capillary forces maintain overpressured gas shale.

Repair of a mixed form of supracardiac total anomalous pulmonary venous connection.

Total anomalous pulmonary venous connection is a rare congenital heart defect. We report an infant with a mixed form of supracardiac TAPVC, in whom all pulmonary veins, except the right upper, entered a pulmonary venous confluence that is connected to a vertical vein and drained into the superior vena caval-right atrial junction. Several segmental right upper pulmonary veins entered the superior vena cava, superior to the entry of the vertical vein. Surgical repair consisted of the Warden procedure combined with direct anastomosis of the vertical vein to the left atrium. Separate pulmonary venous drainage pathways decreased the risk of post-operative pulmonary venous obstruction. Our patient had an uneventful post-operative course and encouraging 2-month follow-up echocardiography. Careful follow-up is warranted to detect post-operative complications, including obstruction of the pulmonary venous and cavoatrial anastomoses.

Cor triatriatum sinister with left anomalous pulmonary venous drainage to innominate vein: what to do with the vertical vein?

We treated a surgical case of a 47-day-old male infant diagnosed with an unusual type of cor triatriatum sinister (CTS) with left anomalous pulmonary venous drainage to the innominate vein via a vertical vein. After preoperative hemodynamic assessment of pulmonary venous (PV) return, this patient underwent a resection of the fibromuscular membrane between the accessory and the true left atrial chambers, concomitant with vertical vein banding to facilitate a left PV return through a common pulmonary venous collector (CPVC). Catheterization three months after this surgery revealed no obstruction of the PV return to the mitral orifice as well as good growth of the CPVC as a left PV return pathway. The patient has been doing well on aspirin.

Endovenous Thermal Ablation of Prominent Central Forehead Veins (Supratrochlear Veins).

Many patients complain of prominent vertical veins in the center of their forehead, worse when smiling, wrinkling the forehead in bright light, leaning forward, and when vasodilated in heat, when exercising, or with alcohol. Previous attempts to treat these with external laser, sclerotherapy, and phlebectomy have not been successful. To describe a new method of treating prominent vertical forehead veins and to report the early results. We used endovenous laser ablation with a 1470 nm diode laser in 15 patients (F:M 12:3; mean age 38.4 years range 24-69). A bare fiber was used once and a 400-μm single ring radial fiber (Biolitec, Vienna, Austria) in all other cases. Tumescence was placed around the vein and a power of 2 to 3 W with a pullback of 7 to 10 seconds per centimeter. Twelve of the 15 patients (80%) ended up with a good cosmetic result and were satisfied, although 2 needed redo treatment. One patient had minor skin tethering, and 2 (13%) suffered burns-one was the only bare fiber case and the other, the only one where 4 W was used. We present a novel technique to treat prominent vertical forehead veins, with apparently good early results.

Surgical repair of an isolated left-sided partial anomalous pulmonary venous connection in an 18-month-old child.

The isolated left-sided partial anomalous pulmonary venous connection is a rare congenital anomaly. Only 3% of cases have been reported with drainage from the whole left lung into the left innominate vein. This anomaly is often asymptomatic and may go undetected (particularly in non-referral centers) until adulthood when symptoms begin to manifest. Transthoracic echocardiography is the main diagnostic tool; however, computed tomography angiography, and magnetic resonance imaging are widely used nowadays. Herein, we present the case of an 18-month-old girl with the diagnosis of isolated left-sided partial anomalous pulmonary venous connection as the left pulmonary veins were draining into the left innominate vein via a vertical vein. The patient underwent surgical repair by anastomosing the vertical vein to the left atrial appendage using cardiopulmonary bypass and cardiac arrest. The patient was discharged on the fifth day without complications. The precise follow-up for 12months showed improved clinical symptoms, and the successively performed TTE confirmed the excellent result of the operation.

Stability of ice lenses in saline soils

A model of the growth of an ice lens in a saline porous medium is developed. At high lens growth rates the pore fluid becomes supercooled relative to its equilibrium Clapeyron temperature. Instability occurs when the supercooling increases with distance away from the ice lens. Solute diffusion in the pore fluid significantly enhances the instability. An expression for the segregation potential of the soil is obtained from the condition for marginal stability of the ice lens. The model is applied to a clayey silt and a glass powder medium, indicating parameter regimes where the ice lens stability is controlled by viscous flow or by solute diffusion. A mushy layer, composed of vertical ice veins and horizontal ice lenses, forms in the soil in response to the instability. A marginal equilibrium condition is used to estimate the segregated ice fraction in the mushy layer as a function of the freezing rate and salinity.

The evolution of the Dominga Fe-Cu deposit (northern Chile): Insights from mineral textures and micro-CT analysis

The Fe-Cu Dominga deposit (2082 Mt at 23% Fe, 0.07% Cu), located in the Coastal Cordillera of northern Chile, is hosted by volcanic rocks of the Punta del Cobre Formation (131.5 ± 1.5 Ma zircon U-Pb) and into subvolcanic units (Dioritic Complex, 131.6 ± 1.0 Ma zircon U-Pb). The Fe-Cu mineralization is controlled by three structural systems which developed from a transtensional to a transpressional tectonic regime and can be divided into three groups: Early iron, Late iron and Early copper ores. Early iron ores are comprised of magnetite + pyrite + biotite breccia (1A ore), veins (1B ores), layers (1C ores) and disseminated ores (1D ores). Late iron ores are characterized by two groups of magnetite-apatite-actinolite hydrothermal breccias (2A, 2C ores) and syntaxial/antitaxial veins (2B, 2D, 2E ores). Early copper ores occur as syntaxial K-feldspar and quartz + epidote + chalcopyrite veins (3A ores), and as anhydrite + chalcopyrite-rich matrix breccia and veins (3B ores). This work presents a detailed mineral texture study of veins, hydrothermal breccias and disseminated iron-rich layers of the Dominga deposit which aims to determine fluid flow mechanisms associated with both iron and copper ores. The description of vein and breccia textural and internal structures was conducted in thin/polished sections perpendicular and parallel to the wall using optical and Scanning Electron Microscope techniques. In addition, two oriented surface samples were analyzed by computerized X-ray microtomography and numerical fluid flow simulations through the Lattice-Boltzmann method to obtain (3D) permeability anisotropy associated with early iron ores. Microtextures associated with Dominga iron and copper ores suggest that the main mass transfer fluid flow mechanism corresponds to advection (channelized and pervasive fluid flow), regardless of the tectonic regime. However, early copper ores have more complex mineral textures and internal structure due to the recurrence of crack-seal episodes. We propose that the various mineral textures and structures indicate changes in fluid flow direction over time, controlled by the permeability anisotropy of each tectonic regime. Results from numerical fluid flow simulations of early iron ore (1B) veins show a higher value of structural permeability in the vertical direction (kVz), which is consistent with a transtensional tectonic regime and the formation of vertical veins. Moreover, permeability related to 1C layered ore is higher in horizontal directions (kHx, kHy) rather than vertical (kVz) because of the natural permeability anisotropy of volcaniclastic rocks parallel to bedding. However, the kVz value suggests that the development of such layered ores also exhibits a degree of structural control at several length scales consistent with a transtensional regime. These results indicate that the occurrence of early iron ores as veins and layers may be controlled by both primary permeability anisotropy related to each lithology present at the Dominga Fe-Cu deposit and to the tectonic regime at the time. Finally, the Dominga Fe-Cu deposit attests to long lived hydrothermal activity with a transition from early fluids capable of precipitating iron ores under a transtensional system to later-stage fluids which precipitated copper ores under a transpressional regime that generated multiple crack and seal episodes.

Petrography and Mineralogy of the Quartz and Quartz-Feldspar Sulphide Veins in the Pan-African Syenitic Massif of Guider (North Cameroon)

In the syenitic pluton of Guider (593 ± 4 Ma) in the North-West Cameroon domain of Central African Fold Belt, mineralized N-S to NE-SW vertical or sub-vertical quartz and quartz feldspar veins has been recently identified. In this contribution, we present petrography and mineralogy of these veins, in order to constrain their genesis and emplacement mechanisms based on detailed field work, petrographic studies and chemical characterization of minerals by using an electron probe microanalyser (EPMA). Field observations and vein microstructures show that the emplacement of the veins has been controlled by the dextral N-S trending strike-slip shear zones related to the regional D2 deformation phase. The results of mineralogical analysis reveal the co-presence of silicates and metallic minerals that include magnetite, ilmenite, pyrite, bismuthite, galena (very rare) and sulphide complexes (BiPbS, BiAgPbS, FeBiPbCuS, BiFe(TeS), FeBiPbS, BiPbCuS). The gangue is represented by quartz (quartz 1, quartz 2 and quartz 3), feldspars, sericite, chlorite, yellowish brown clay minerals, and hematite. The textural relationships between sulphides, quartz and alteration products show that the mineralization is essentially syn- to late-D2 and suggest that syenitic country rock and dextral shear zones have played an important role in the metallogenesis of these veins. This mineralization shows characteristics for copper-bearing calc-alkaline deposits, but differs from these by its more extensive alteration and its abundance in hematite. Substitutions of Al(IV) by Si(IV) in sericite associated with the sulphide mineralization and cataclastic deformation suggest that the temperature of trapping of the fluids is between 230°C and 275°C.

Vertical vein stenting as a therapeutic strategy for obstructed supracardiac total anomalous pulmonary venous connection.

Vertical vein stenting as a therapeutic strategy for obstructed supracardiac total anomalous pulmonary venous connection.

P1488 Anomalous origin of left coronary artery from right pulmonary artery in association with scimitar syndrome

Abstract Clinical Presentation A full-term neonate was referred to our institution because of respiratory distress. CXR was significant for right lung hypoplasia and mild cardiomegaly. ECG showed normal sinus rhythm, right atrial enlargement, and right ventricular hypertrophy with no signs of ischemia. Imaging Findings The initial echocardiogram demonstrated PAPVD with the right upper pulmonary vein draining into IVC/RA junction with flow acceleration (mean gradient= 7 mmHg), moderate ASD, small muscular VSD with left-right shunting, moderate PDA with bidirectional shunting. Forward flow was seen in the proximal part of left main coronary artery (LMCA). RV systolic pressure was supra-systemic with a qualitatively moderately reduced RV systolic function. The patient was taken to the catheterization lab where MPA angiography revealed an antegrade flow from the RPA into LMCA supplying both the anterior descending and the circumflex arteries. A selective injection within the scimitar vein showed drainage of the right lung into a vertical vein connecting with stenosis to IVC. A follow up echocardiogram to re-examine the coronary origin revealed an anomalous origin of LMCA from proximal RPA; 3 mm distal to branch pulmonary artery bifurcation with mainly antegrade low velocity flow into LMCA and LAD. (Image 1) Role of Imaging in Patient Care - Imaging of the coronary origin in patients with ALCAPA can be challenging especially if the LMCA originates from RPA. Also, the presence of pulmonary hypertension might contribute to maintain coronary perfusion and lead to misinterpretation of the antegrade flow in LMCA and its branches. - In certain situations, cardiac catheterization is essential to make the diagnosis of ALCAPA which prevented a potentially catastrophic outcome. Catheter intervention with a series of balloon dilations of the stenotic scimitar vein was successful in relieving the stenosis. Summary/Discussion Points: - Extensive review of the available literature revealed only three cases of Scimitar syndrome associated with ALCAPA. In all of these cases, the LMCA originated from the posterior sinus of MPA. Our case is the first to report ALCAPA from RPA in association with Scimitar syndrome. This presentation might have led to the initial misinterpretation of the echocardiography images. - The presence of pulmonary hypertension in our patient maintained an adequate antegrade flow across the LMCA preventing significant coronary steal and signs of myocardial ischemia. - The report highlights the challenges in making the diagnosis of ALCAPA with echocardiograms. Moreover, we discuss the role of cross-sectional and invasive imaging to rule out potential coronary arteries anomalies in patients with Scimitar syndrome, as this a rare although a very significant association that may have important implications in their outcomes. Abstract P1488 Figure. ALCAPA origin from RPA

Supra-Cardiac Total Anomalous Pulmonary Venous Connection via Rare Right-Sided Vertical Vein

A Total Anomalous Pulmonary Venous Connection (TAPVC) is an uncommon congenital anomaly which occurs as result of defective development or early atresia of common pulmonary vein. TAPVC is categorized into four with supracardiac variety occurring most frequently. Common pulmonary vein anomaly results in the retention of cardinal or umbilico-vitelline drainage systems. If cardinal venous system persists, it provides channels to the innominate or azygous vein, Superior Vena Cava (SVC). This case series reports two cases of supracardiac TAPVC draining into SVC via right-sided vertical vein. Careful evaluation before surgical repair is vital for such complex cardiac anomalies.

Complete cor triatriatum sinister misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound

Cor triatriatum sinister (CTS) is characterized by the presence of a fibromuscular membrane dividing the left atrium into two chambers. The postero-superior and proximal chamber of CTS receives blood from four pulmonary veins, whereas the antero-inferior and distal chamber (true left atrium) connects to mitral valve and left atrial appendage (LAA). CTS can be classified into two types, complete and partial CTS. We reported a case of fetal autopsy-confirmed complete CTS that had been misdiagnosed as atresia of the common pulmonary vein on prenatal ultrasound. At 25 gestational weeks, fetal sonography revealed that the pulmonary venous angle on the top of the left atrium disappeared and no vertical vein was found around the common pulmonary venous cava formed by bilateral pulmonary veins. Thus, atresia of the common pulmonary venous cava was considered. Fetal autopsy after induction further confirmed the case was complete CTS. Key words: Cor triatriatum; Ultrasonography, prenatal; Pulmonary veins; Vascular malformations; Diagnostic errors

Supracardiac Total Anomalous Pulmonary Venous Connection

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease in which there is developmental absence of connection of all four pulmonary veins with the left atrium. To report a rare case and share our experience in surgery and post-operative management for supracardiac TAPVC. Patient with supracardiac TAPVC with atrial septal defect (ASD) secundum variety with rudimentary patent ductus arteriosus (PDA) underwent rechanneling of pulmonary veins to left atrium (LA) with gluteryldehye treated autologous pericardial patch closure of ASD with ligation of ascending vertical vein and ligation of rudimentary PDA.Post operatively there were no events of pulmonary hypertensive crisis, low cardiac output syndrome, right heart failure or conduction defect were observed and echocardiogram showed adequate pulmonary venous drainage with no residual shunt across the interatrial septum. Marked development in surgical results of TAPVC has been observed in recent years with declining mortality rate from 65% in early sixties to 5% in current surgical scenerio.
 KYAMC Journal Vol. 10, No.-2, July 2019, Page 118-121

Phragmites Communis Leaves with Anisotropy, Superhydrophobicity and Self-Cleaning Effect and Biomimetic Polydimethylsiloxane (PDMS) Replicas

Phragmites communis leaf (PCL) is anisotropic, superhydrophobic and shows a self-cleaning effect. The water contact angle (WCA) values along the vertical and parallel vein directions on PCL are 153° ± 2° and 148° ± 2°, respectively. In contrast, the water sliding angle (WSA) values along the vertical and parallel vein directions for PCL are 12° ± 2° and 7° ± 2°, respectively. The epidermal wax makes the leaves intrinsically hydrophobic. The microstructure of the PCL surface shows sub-millimetre-, micron- and nanometre-scale structures. The sub-millimetre ridge structure is the main reason for the anisotropy of the leaves. The micron-scale papillae structure has a strong hydrophobic enhancement effect, and the nanoscale sheet structure is the key factor in achieving a stable Cassie state, as well as superhydrophobicity and self-cleaning activities. PCL-like polydimethylsiloxane (PDMS) samples fabricated by template transfer technology exhibited the sub-millimetre ridge structure and micron-scale papillae from the natural PCL; they also show obvious anisotropy and strong hydrophobicity and have a certain self-cleaning effect. The WCA and WSA values along the vertical and parallel vein directions on PCL are 146° ± 2°, 23° ± 2°, 142° ± 2° and 19° ± 2°, respectively. The preparation of a biomimetic PCL surface has broad application prospects in micro-fluidic control and the non-destructive transmission of liquids.

Prenatal ultrasonographic features of fetal total anomalous pulmonary venous connection

Objective To investigate the prenatal ultrasonographic features of fetal total anomalous pulmonary venous connection (TAPVC). Methods Forty-one cases who received prenatal ultrasound examination and then were diagnosed with TAPVC by postnatal surgery at the Third Affiliated Hospital of Zhengzhou University from June 2013 to June 2018 were enrolled. Echocardiography findings of all cases were analyzed retrospectively, and the prenatal imaging features were summarized. Results Among all cases, 21 were confirmed as supracardiac type, 14 as intracardiac type, four as infracardiac type and two as mixed type after surgery. The echocardiographic features of TAPVC were as follows: all 41 cases showed smooth posterior wall of left atrium without visible part of pulmonary venous connected to the left atrium in the-four chamber view; in 33 cases, the space between left atrium and descending aorta was widened and the pulmonary venous confluence was observed in the four-chamber view; ten cases showed a dilated coronary sinus in the four-chamber view and 27 cases showed vertical vein in the three vessels and trachea or the upper abdomen view. None of the 41 cases was complicated by other structural intracardiac abnormalities. However, seven cases were complicated by obstruction of blood flow, and the blood flow velocity measured by Doppler ultrasound was 0.76 m/s to 1.25 m/s. Conclusions Blood flow in pulmonary veins should be carefully observed in prenatal ultrasonography, and anomalous pulmonary venous connection should be considered when pulmonary veins do not connect to the left atrium. Key words: Pulmonary veins; Congenital abnormalities; Scimitar syndrome; Ultrasonography, prenatal

Vertical vein aneurysm in supracardiac total anomalous pulmonary venous connection.

Aneurysmal dilatation of the vertical vein in a case of supracardiac total anomalous pulmonary venous connection (TAPVC) is an extremely rare condition. It has been reported to occur secondary to severe compression of the vertical vein when it traverses between the left bronchus and the left pulmonary artery. We present a 14-year-old male with supracardiac TAPVC with a vertical vein aneurysm, probably secondary to stenosis caused by a thin membranous web just proximal to the aneurysm.

Atypical Mixed Total Anomalous Pulmonary Venous Connection: A Case Report

A 2 years old boy presented to us with a history of repeated respiratory tract infections and bluish discoloration of tongue, lips and figure tips for last 18 months. Echocardiography and Computed tomography (CT) angiogram revealed total anomalous pulmonary venous connection (TAPVC) mixed type (supracardiac and cardiac);all pulmonary veins drain into a common chamber behind left atrium (LA) and left lower pulmonary vein (LUPV) drains to vertical vein and common chamber both.The patient underwent rerouting of pulmonary veins and vertical vein ligation above the drainage of LUPV.
 Bangladesh Heart Journal 2018; 33(2) : 138-140

Influence of vertical cylindrical tetrahydrofuran hydrate veins on fine-grained soil behaviour

Over the last 10 years, marine gas hydrate drilling expeditions utilizing advances in pressure coring techniques and imaging have routinely encountered gas hydrates residing in fine-grained sediments. The hydrate typically occurs as fracture-filling, near vertical, veins that displace the sediment, potentially leading to increased sediment strength that may prevent normal consolidation of the sediment thus leading to underconsolidation. Destabilization of this hydrate, through climate change or human activity on the seafloor, may cause dramatic loss of strength of the sediment and pose a significant geohazard. To assess the impact of hydrate veins on sediment behaviour, this paper reports on a series of consolidated (CU) and unconsolidated undrained (UU) triaxial tests carried out on fine-grained soil specimens hosting simplified, vertical, cylindrical tetrahydrofuran (THF) hydrate veins of varying diameters. The results show that increasing hydrate vein diameter significantly increases strength and stiffness, including the development of post-peak strain-softening. The mode of failure of the hydrate veins influenced the specimen strength, but did not affect the specimen stiffness. Hydrate dissolution during CU tests prevented quantitative comparison with UU tests. However, CU test results on the soil specimens containing the largest hydrate vein suggest that increasing lateral confining stresses increase the sediment strength.