[Obstruction of inferior vena cava (vena cava inferior syndrome)].
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Budd-Chiari Syndrome↗
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[Study of the glucose concentration in five vascular regions -- aorta, arteria pulmonalis, vena cava inferior, vena cava superior, vena hepatica -- in childhood (author's transl)].
Using the Beckman glucose analyzer, glucose concentration was determined in the serum of the fasting blood in five vascular regions -- aorta, arteria pulmonalis, vena cava inferior, vena cava superior, vena hepatica -- of 52 children (ages 2,5 months up to 14 years and 3 months, x = 6 years and 3 months, male = 28, female = 24) with a healthy metabolism. The comparison of the average values of the glucose concentrations determined in five vascular regions in childhood showed that the glucose concentration in the vena hepatica was statistically significant higher than in the other vascular regions. Moreover the comparison of the glucose concentrations revealed that the values in the vena cava inferior were statistically significant higher as compared to the values in the vena cava superior. The glucose concentrations in the arteria pulmonalis, the vena cava superior and the aorta were nearly equal. Compared with the older children, the younger children had in all the investigated vascular regions lower glucose concentrations.
Adolescent↗
Doppler flow velocity patterns of the superior vena cava, inferior vena cava, hepatic vein, coronary sinus, and atrial septal defect: a guide for the echocardiographer.
Pulsed-wave Doppler provides the echocardiographer the advantage of range resolution; confusion as to the source of Doppler shift information is unusual. One area of the heart that may lead to interpretive difficulties, however, is the right atrium because the right atrium receives blood flow from three venous sources and from the left atrium when an atrial septal defect is present. Our article presents information on the normal pulsed-wave Doppler spectral displays for the superior vena cava, inferior vena cava, hepatic vein, and coronary sinus. Because it is clinically pertinent, methods on how to differentiate these normal venous flow patterns from atrial septal defect flow will be emphasized.
Blood Flow Velocity↗
Two-step procedure in Budd-Chiari syndrome with severe intrahepatic vena cava stenosis: vena cava stenting and portocaval shunt.
Budd-Chiari syndrome is characterized by hepatic venous outflow obstruction, which often leads to death as a result of portal hypertension and liver failure. Venous decompressive shunt surgery and liver transplantation represent efficient surgical treatments of Budd-Chiari syndrome. In the case presented here, severe intrahepatic compression of the inferior vena cava (IVC) was caused by the hypertrophic caudate lobe. A mere portocaval shunt was not feasible because of a large pressure gradient across the intrahepatic stenosis. A two-step procedure with preoperative radiological dilation and stenting of the intrahepatic IVC followed by a portocaval shunt was successfully performed. Consequently, liver transplantation and its subsequent immunosuppression could be avoided.
Adult↗
Idiopathic dilatation of the superior vena cava (superior vena cava dilatation).
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Aneurysm↗
Leiomyosarcoma of the superior vena cava producing superior vena cava syndrome and heart tamponade.
An autopsy case of primary leiomyosarcoma arising in the superior vena cava is presented. A 44 year old Japanese man presented with superior vena cava syndrome and eventually died due to heart tamponade and acute renal failure. Autopsy revealed that the superior vena cava was occluded with a tumor that had invaded the pericardium and right thoracic cavity. Primary caval venous leiomyosarcoma is a rare but lethal disease and most cases arise from the inferior vena cava. This case represents a very rare case of leiomyosarcoma with the rare clinical findings of superior vena cava syndrome and heart tamponade.
Adult↗
Stenting of superior vena cava and inferior vena cava for symptomatic narrowing after repeated atrial surgery for D-transposition of the great vessels.
Double venous stenting of the superior vena cava and inferior vena cava was successfully performed after failed balloon angioplasty in a young woman who had venoatrial narrowing and kinking after repeated Mustard procedure for D-transposition of great vessels. Self-expanding metallic stents were used. Angiography showed that the first stent was fully patient after six months when a second stent was implanted. This operation was followed by sustained clinical improvement. The present report shows the feasibility and success of stenting of the great veins when postoperative narrowing or kinking is unresponsive to balloon angioplasty alone.
Adolescent↗
Ureteropelvic junction obstruction caused by accessory renal vessels in association with preureteral vena cava and vena caval duplication.
An apparent ureteropelvic junction obstruction on the right side may herald an array of anomalous conditions for which the surgeon should be prepared. A case is presented in which ureteropelvic junction obstruction caused by accessory renal vessels was found in association with a preureteral vena cava and a vena caval duplication on the right side. The embryology of caval anomalies associated with preureteric vena cava is reviewed.
Child, Preschool↗
Transposition of the great arteries, primum atrial septal defect, azygos continuation of the inferior vena cava, bilateral superior venae cavae and dextrocardia with centrally placed liver.
Successful surgical correction of transposition of the great arteries in a nine-year-old girl with dextrocardia, primum atrial septal defect, bilateral venae cavae, and azygos continuation of inferior vena cava is reported. The patient was cooled on cardiopulmonary bypass and the operation performed under circulatory arrest at 19 degrees C. nasopharyngeal temperature. The problems of diagnosis and management are discussed.
Abnormalities, Multiple↗
Computed tomography-guided central venous catheter placement in a patient with superior vena cava and inferior vena cava occlusion.
An 18-year-old man with a gastrointestinal hypomotility syndrome required lifelong parenteral nutrition. Both the superior and inferior vena cava were occluded. Computed tomography guidance was used to place a long-term central venous catheter via a large tributary to the azygos vein.
Adolescent↗
[A case of Kartagener's syndrome with bilateral superior vena cava and absent inferior vena cava].
A 39-year-old man with a history of repeated attacks of acute bronchitis and pneumonia since childhood was admitted complaining of cough, sputum, and a high fever. A diagnosis of Kartagener's syndrome was made because of the presence of mirror-image dextrocardia with complete situs inversus, bronchiectasis in right B6 and B10, and chronic sinusitis. Examination of the ciliary ultrastructure of the bronchial epithelium showed defective inner dynein arms and impaired nasal clearance was suggested by the saccharin particle method. Contrast venography of great veins revealed a McCotter type II bilateral superior vena cava and an absent inferior vena cava with (hemi-) azygos continuation. A search to find a similar case in the literature failed. Abnormal ciliary movement from the embryonic period was implicated as a causative factor in Kartagener's triad and the morphological abnormalities of the great veins.
Adult↗
Transvenous defibrillator implantation in patients with persistent left superior vena cava and right superior vena cava atresia.
In this report a transvenous cardioverter defibrillator implantation is described in two patients with a persistent left-sided superior vena cava and right SVC atresia. In the first case, manoeuvring of the guide wire inserted through the left subclavian vein into the SVC proved impossible, revealing a left SVC originating from the left brachiocephalic vein with an acute corner. Changing the side of implantation and inserting a CPI Endotak catheter through the right subclavian vein, the lead was easily advanced through the left SVC into the coronary sinus and then into the right atrium with the tip abutting the lateral atrial wall. Subsequent manoeuvres allowed passage of the tip of the catheter into the right ventricular apex with the proximal defibrillation coil of the Endotak lead in the low left SVC, with its distal limit at the junction with the coronary sinus. A biphasic waveform single pathway RV - > left SVC successfully defibrillated with a stored energy of 5 J. In the second patient, implantation of a transvenous Medtronic system was possible from a left infraclavicular approach. A tripolar RV coil was inserted into the right ventricle via the persistent left SVC and contiguous coronary sinus. Because of the acute angle required to enter the RV in this second case, the RV lead was looped in the right atrium in order to enter the RV in a satisfactory, albeit atypical RV location. This patient was successfully defibrillated with a 5 J monophasic waveform delivered between the RV coil, a CS/left SVC coil, and a subcutaneous patch. In conclusion, both of these patients illustrate the ability to use transvenous ICDs successfully in patients with persistent left superior vena cava although the implantation technique deviates substantially from traditional methods.
Adolescent↗
Partially unroofed coronary sinus syndrome with persistent left superior vena cava, absent right superior vena cava and right-sided pericardial defect.
Partially unroofed coronary sinus syndrome with persistent left superior vena cava is a rare congenital anomaly. It frequently produces a right-to-left shunt. We report a case in which a large left-to-right shunt was present, because of the obstruction to left ventricular inflow as a result of the dilated coronary sinus. This abnormality was associated with absent right superior vena cava and a partial pericardial defect on the right side.
Adult↗
Persistent left superior vena cava and right superior vena cava drainage into the left atrium without arterial hypoxemia.
A 46 year old patient who presented with an acute myocardial infarction was discovered to have a systemic venous communication with the left heart during attempted insertion of a pulmonary flotation catheter. There was no evidence of cyanosis or systemic arterial desaturation. A right superior vena cava that emptied into the right superior pulmonary vein and a persistent left superior vena cava draining into the coronary sinus were confirmed pathologically after death related to a brain abscess. The embryology, physiology and noninvasive diagnostic approach to this unique venous anomaly are discussed.
Cardiac Catheterization↗
[Evaluation of congenital vena cava anomalies and acquired vena cava obstructions after atrial switch operation using spiral computerized tomography and 3-dimensional reconstruction].
We report spiral-CT findings in adult patients with congenital abnormalities of the vena cava and systemic venous obstructions after atrial switch operation. Especially systemic venous obstruction is a well-known complication following Mustard procedure for transposition of the great arteries. The results demonstrate that computed tomography, particularly with the use of 3-dimensional surface reconstruction, is very useful as a highly sensitive procedure for the detailed depiction of abnormalities of the vena cava or of residua and sequelae after inflow correction for complete transposition. Demonstration of such abnormalities or obstructions after atrial switch operation is important, since the recognition and quantitation of caval anomalies by clinical techniques is unreliable and indeed often impossible. Imaging procedures such as spiral computed tomography are important for this purpose. Advantages of spiral computed tomography, particularly with 3-dimensional reconstruction, are discussed.
Adolescent↗
Absent right superior vena cava with hypoplastic proximal inferior vena cava.
We describe the precise preoperative diagnosis of a very rare anomaly that comprises absence of the right superior vena cava, persistence of the left superior vena cava, and proximal hypoplasia of the inferior vena cava draining into the left superior vena cava via the hemiazygos vein associated with a large atrial septal defect and tricuspid regurgitation.
Adolescent↗
[Unilateral left superior vena cava in absent right superior vena cava. Modern imaging diagnosis and clinical relevance].
Cardiological and radiological findings in a 64-year-old patient with persistent left superior vena cava and absent right-sided superior vena cava are described. Presence of a persistent left superior vena cava (PLSVC) is considered to be one of the most frequent anomalies of the systemic venous return. It occurs most often in association with a right-sided superior vena cava and only in rare cases with an absent or atretic right-sided superior vena cava. This malformation is often associated with other congenital heart defects, but without major hemodynamic significance. The variation may cause difficulties in venous catheterization, pacemaker electrode insertion or during cardiopulmonary bypass. The diagnosis can be confirmed by angiography, computed tomography and nuclear magnetic resonance imaging.
Diagnostic Imaging↗
Transvenous interruption of the inferior vena cava. New model of vena cava filter. Preliminary results in 35 cases.
Partial interruption of inferior vena cava (I.C.V.) forms an integral part of treatment of thromboembolic disease. The most frequently used filter worldwide is currently that of Greenfield, but although its effectiveness and permeability are remarkable it can be the subject of transfixions, sliding movements and migrations. A new model of the authors' own conception is presented which eliminates these faults. The "2612" filter is based on the same concepts, but has added to it 6 lateral flanges soldered to the base of the arms, these applying pressure to the I.V.C. and ensuring its perfect positioning, and 12 hooks (6 turned downwards and 6 upwards) ensuring perfect stability. Results of a multicentre trial in 35 patients, after insertion of the "2612" filter and follow-up assessment after 3 months (28 cases) by cavography and in some patients by a scan, showed permeability of 93% and total efficacy. No side effects were reported. This filter appears to represent true progress in the means of interrupting I.V.C., and further studies are contemplated.
Adult↗