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Jeong ER, Kang EJ, Jeun JH. Pictorial Essay: Understanding of Persistent Left Superior Vena Cava and Its Differential Diagnosis. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:846-860. [PMID: 36238921 PMCID: PMC9514584 DOI: 10.3348/jksr.2021.0192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 06/16/2023]
Abstract
Persistent left superior vena cava (PLSVC) is a rare congenital, thoracic, and vascular anomaly. Although PLSVCs generally do not have a hemodynamic effect, several types of PLSVC and some cardiac anomalies may manifest with clinical symptoms. The presence of PLSVC can render catheterization via left subclavian access difficult when placing a pacemaker or central venous catheter. As such, recognizing a PLSVC that is typically incidentally discovered can prevent complications such as vascular injury. Differentiating vessels found in a similar location as PLSVC is necessary when performing thoracic vascular procedures. This pictorial essay explains the multi-detector CT findings of a PLSVC, and provides a summary of other blood vessels that require differentiation during thoracic vascular procedures.
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Low KE, Premathilake P, Pullaperuma L, Angel T. Congenital Anomalous Azygos Vein Drainage Causing Pulmonary Embolus in a 91-Year-Old Patient. Eur J Case Rep Intern Med 2021; 8:002978. [PMID: 34912739 PMCID: PMC8667999 DOI: 10.12890/2021_002978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 11/29/2022] Open
Abstract
Background Retroaortic course and azygos continuation of aberrant left brachiocephalic vein is a rare venous anomaly, which is usually associated with congenital heart disease and pulmonary artery anomalies. Venous stasis is a cause of pulmonary arterial thromboembolism, which can result from venous anomalies. Case presentation We describe the case of a 91-year-old female admitted to our hospital with shortness of breath diagnosed with pulmonary embolism and infarctions by a CT pulmonary angiogram. CT also showed aberrant left brachiocephalic vein with vascular webs at its retroaortic course and azygos continuation, suggesting chronic venous thrombosis, which was considered to be the suspected source of emboli. Conclusion To our knowledge, this is the first report presenting this vascular anomaly manifesting with chronic venous thrombosis and pulmonary embolism. Although rare, awareness and identification of this entity is important, especially in the absence of obvious embolic sources or in patients with recurrent embolus/consolidation. LEARNING POINTS
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Affiliation(s)
- Kai En Low
- Radiology Department, Luton and Dunstable Hospital, Luton, United Kingdom
| | | | | | - Tammy Angel
- Department of Elderly Medicine, Luton and Dunstable Hospital, Luton, United Kingdom
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Verma M, Pandey NN, Ramakrishnan S, Jagia P. Anomalous subaortic course of brachiocephalic vein: Evaluation on multidetector computed tomography angiography. J Card Surg 2021; 36:4604-4610. [PMID: 34637169 DOI: 10.1111/jocs.16068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/30/2022]
Abstract
AIM To evaluate the morphology and associated cardiovascular abnormalities in patients with an anomalous subaortic course of brachiocephalic vein on multidetector computed tomography (CT) angiography. MATERIAL AND METHODS A retrospective study was performed at a tertiary referral institute to identify patients with subaortic brachiocephalic vein on multidetector CT (MDCT) angiography using dual source CT scanner between January 2014 and July 2021. The morphology of the subaortic brachiocephalic vein along with the cardiovascular anatomy and associated anomalies were evaluated. RESULTS Out of 4349 patients who had undergone MDCT angiography for evaluation of congenital heart diseases, we identified 126 (2.9%) patients with subaortic brachiocephalic vein. The subaortic brachiocephalic vein was left-sided in 125 patients while a right-sided subaortic brachiocephalic vein was identified in a patient with left isomerism. Common cardiovascular associations included tetralogy of Fallot (109/126; 88.1%), double outlet right ventricle (8/126; 6.3%) and common arterial trunk (5/126; 3.9%). The presence of a right aortic arch was seen in 78/126 (62%) patients. Some degree of right ventricular outflow obstruction was present in 119/126 (94.4%) patients; pulmonary stenosis was seen in 78 (62%) patients while pulmonary atresia was seen in 41 (32.5%) patients. CONCLUSION A subaortic brachiocephalic vein can coexist with various complex congenital heart diseases, most commonly tetralogy of Fallot and commonly associated with right aortic arch and pulmonary stenosis/atresia. It is important to identify this anomalous course of brachiocephalic vein before performing surgical procedures or venous catheterization to avoid potential complications.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Chowdhury UK, Anderson RH, Sankhyan LK, George N, Goja S, Pandey NN, Arvind B, Tharranath I. Surgical management of lesions encountered in the setting of the retroaortic left brachiocephalic vein. J Card Surg 2021; 36:4280-4291. [PMID: 34392559 DOI: 10.1111/jocs.15907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Although the retroaortic left brachiocephalic vein in isolation is of no clinical importance, its recognition in the setting of associated lesions is important. We sought to address issues concerning the influence of isomerism, the establishment of diagnosis, and its importance in various surgical and interventional procedures. METHODS A total of 80 published clinical and necropsy studies in the setting of a retroaortic left brachiocephalic vein described 250 patients. Clinical presentation, radiographic, ultrasonographic findings, contrast echocardiography, computed-tomographic angiocardiography, magnetic resonance imaging, and angiocardiography provided the diagnostic information prior to considering the surgical approach to the associated cardiac anomalies. RESULTS Among 250 reported cases, three-quarters had associated congenitally malformed hearts. Of these 189 patients, all but seven had usual atrial arrangement. Right isomerism was reported in five patients and two patients having left isomerism. Almost two-thirds had tetralogy of Fallot or its variants, over four-fifths had malformations involving the outflow tract, two-thirds had a right aortic arch with two patients having a cervical aortic arch, and onepatient had double aortic arch. Various innovative individualized surgical procedures were employed with an overall perioperative mortality of 3.4%. CONCLUSIONS Although the retroaortic left brachiocephalic vein is asymptomatic, its recognition during clinical investigation should raise the possibility of an association with other malformations, especially right aortic arch, ventricular septal defect, and anomalies of the outflow tracts. We submit that an increased appreciation of this venous anomaly may facilitate surgical planning, endovascular procedures, placement of central venous lines, and transvenous pacemakers.
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Affiliation(s)
- Ujjwal K Chowdhury
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Robert H Anderson
- Institute of Biomedical Sciences, Newcastle University, Newcastle-upon-Tyne, UK
| | - Lakshmi K Sankhyan
- Cardiothoracic Centre, All India Institute of Medical Sciences, Bilaspur, India
| | - Niwin George
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Arvind
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Shang J, Chen D, Fang W, Dong F. Isolated subclavian or brachiocephalic arteries with tetralogy of Fallot, left retro-aortic brachiocephalic vein. Cardiovasc Pathol 2020; 51:107304. [PMID: 33157206 DOI: 10.1016/j.carpath.2020.107304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Isolated subclavian or brachiocephalic artery are uncommon aortic arch anomalies. Here we report the anatomy and histology of this disease. METHODS Four cases of congenital isolated subclavian or brachiocephalic artery in fetuses are described. RESULTS We identified one case of right aortic arch with isolated left subclavian artery associated with the tetralogy of Fallot, two cases of right aortic arch with isolated left brachiocephalic artery (one case with left retro-aortic brachiocephalic vein), and one case of left aortic arch with isolated right subclavian artery associated with coarctation of the aorta and cervical aortic arch. The proximal subclavian or brachiocephalic artery is arterial duct. CONCLUSION Aortic arches with an isolated subclavian or brachiocephalic artery are often associated with the tetralogy of Fallot. It also can be associated with rare abnormalities such as left retro-aortic brachiocephalic vein or cervical aortic arch. Isolated LBA can be associated with microdeletion chromosome 22q11.
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Affiliation(s)
- Jianfeng Shang
- Department of Pathology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Chen
- Department of Pathology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
| | - Wei Fang
- Department of Pathology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fang Dong
- Department of Pathology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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GÜRÜN E, AKDULUM İ. A rare congenital anomaly of mediastinal vascular structures; isolated retroaortic left brachiocephalic vein. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2020. [DOI: 10.32322/jhsm.785575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Pandey NN, Bhambri K, Sinha M, Sharma A, Jagia P. Incidence of systemic venous anomalies in tetralogy of Fallot on multidetector CT angiography: A retrospective single-center study of 973 patients. J Card Surg 2020; 35:2254-2263. [PMID: 32720410 DOI: 10.1111/jocs.14897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The present study sought to estimate the incidence and evaluate the patterns and associations of systemic venous anomalies in patients with tetralogy of Fallot on multidetector computed tomography (CT) angiography. METHODS We retrospectively reviewed CT angiographies of 973 pediatric age group patients diagnosed with tetralogy of Fallot, performed at our institution between 1st January 2015 and 31st December 2019, for systemic venous drainage patterns. We also proposed a structured classification and reporting system on CT angiography which would simplify the characterization, classification, and communication of these anomalies. RESULTS Variations in systemic venous drainage patterns were observed in 146 (15.01%) patients. The most commonly observed anomaly was persistence of left superior caval vein, which was seen in 112 (11.51%) patients, with the most prevalent pattern being the presence of bilateral superior caval veins with no intercommunicating vein (n = 85). The second most common anomaly observed was presence of anomalous brachiocephalic vein (39/973 [4.01%]). Patients with an anomalous course of brachiocephalic vein had significantly higher prevalence of a right aortic arch than those without (23/39 [58.97%] vs 188/934 [20.13%]; P < .0001). Similarly, a higher prevalence of pulmonary atresia was noted in patients with an anomalous course of brachiocephalic vein compared to those without (8/39 [20.51%] vs 80/934 [8.57%]; P = .0109). CONCLUSION There is a high incidence of anomalies of superior caval veins and brachiocephalic vein in the presence of tetralogy of Fallot. With advancements in corrective cardiac surgery and use of intraoperative cardiopulmonary bypass, the presence of systemic venous anomalies assumes greater significance making preoperative identification of these anomalies imperative.
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Affiliation(s)
- Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Kanika Bhambri
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Mumun Sinha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Ramesh Babu CS, Kumar A, Gupta O. Anomalous subaortic left brachiocephalic vein: Prevalence and associated anomalies. J ANAT SOC INDIA 2020. [DOI: 10.4103/jasi.jasi_111_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Retroaortic course of left innominate vein is a rare venous anomaly which is usually associated with CHD. Isolated retroaortic innominate vein is exceedingly rare with only a handful of reported cases. We report an otherwise healthy newborn with isolated retroaortic innominate vein and right aortic arch, a combination which has previously not been reported.
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Retroaortic innominate vein in a patient with transposition of the great arteries: the surgical implications. Cardiol Young 2019; 29:840-841. [PMID: 31159898 DOI: 10.1017/s1047951119000763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe the case of a newborn infant with transposition of the great vessels and a retroaortic innominate vein. This is a previously undescribed association. The decision was made to incorporate the retroaortic innominate vein into the Lecompte procedure at the time of surgery to avoid the risk of superior caval vein syndrome.
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Mądry W, Karolczak MA, Grabowski K. Anomalous retroaortic paravertebral course of the left innominate vein in a child with atrial septal defect. J Ultrason 2019; 19:71-74. [PMID: 31088015 PMCID: PMC6750173 DOI: 10.15557/jou.2019.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2019] [Indexed: 11/25/2022] Open
Abstract
We report the case of a 2.5-year-old boy with atrial septal defect in whom anomalous position of the left innominate vein was detected on preoperative ultrasound examination. Before joining the right brachiocephalic vein, the vessel extended from the left to the right and downward beyond the descending aorta. It was considerably flattened by the thoracic vertebral column, and was invisible on ultrasonography in this section. The appearance of the visible segments raised a suspicion of an anomalous course of persistent left superior vena cava draining into the left atrium, dilated azygos vein in a case of interrupted inferior vena cava, or partial anomalous pulmonary venous return. Since all doubts had to be resolved before open heart surgery, a decision was made to expand the diagnostic work-up to include computed tomography angiography. We present the echocardiographic and computed tomography findings of this unusual and previously unreported case of anomalous venous return.
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Affiliation(s)
- Wojciech Mądry
- Department of Cardiac Surgery and General Pediatric Surgery, Medical University of Warsaw , Warsaw , Poland
| | - Maciej A Karolczak
- Department of Cardiac Surgery and General Pediatric Surgery, Medical University of Warsaw , Warsaw , Poland
| | - Krzysztof Grabowski
- Department of Cardiac Surgery and General Pediatric Surgery, Medical University of Warsaw , Warsaw , Poland
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Kobayashi M, Ichikawa T, Koizumi J, Hashimoto J, Yamamuro H, Hara T, Nomura T, Kanda S, Imai Y. Aberrant Left Brachiocephalic Vein versus Persistent Left Superior Vena Cava without Bridging Vein in Adults: Evaluation on Computed Tomography. Ann Vasc Dis 2018; 11:535-541. [PMID: 30637011 PMCID: PMC6326043 DOI: 10.3400/avd.oa.18-00098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Objective: Persistent left superior vena cava without bringing vein (PLSVC w/o BV) is a common thoracic venous anomaly, while aberrant left brachiocephalic vein (ALBCV) is an uncommon condition. We compared the incidences of the two venous anomalies and assessed congenital cardiovascular diseases (CCDs) in adults using computed tomography (CT). Materials and Methods: We reviewed the recorded reports or CT images of 49,494 adults for PLSVC w/o BV and ALBCV in two hospitals. We determined incidences of two venous anomalies and the rate of associated CCDs. Results: 76 PLSVCs w/o BV and 27 ALBCVs were found. The incidence of PLSVC w/o BV was 0.15% and the incidence of ALBCV was 0.055%. PLSVC w/o BV had higher incidence than ALBCV (p<0.001). Four PLSVCs w/o BV and one ALBCV were associated with congenital heart diseases. Two PLSVCs w/o BV and four ALBCVs were associated with congenital aortic arch anomaly (CAAA). ALBCV had higher incidence of associated CAAA than PLSVC w/o BV (P=0.02). Conclusion: The incidence of ALBCV was <50% that of PLSVC w/o BV. The two venous anomalies found on CT during adulthood were rarely associated with CCDs.
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Affiliation(s)
- Makiko Kobayashi
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan.,Division of Diagnostic Radiology, Hiratsuka City Hospital, Hiratsuka, Kanagawa, Japan
| | - Tamaki Ichikawa
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Koizumi
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Hiroshi Yamamuro
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Takuya Hara
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Takakiyo Nomura
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Shigetaka Kanda
- Department of Cardiac Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yutaka Imai
- Department of Radiology, Tokai University School of Medicine, Isehara, Kanagawa, Japan
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Yamamuro H, Ichikawa T, Hashimoto J, Ono S, Nagata Y, Kawada S, Kobayashi M, Koizumi J, Shibata T, Imai Y. Congenital anomalies of the left brachiocephalic vein detected in adults on computed tomography. Jpn J Radiol 2017; 35:597-605. [PMID: 28849388 DOI: 10.1007/s11604-017-0673-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/28/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Anomalous left brachiocephalic vein (BCV) is a rare and less known systemic venous anomaly. We evaluated congenital anomalies of the left BCV in adults detected during computed tomography (CT) examinations. MATERIALS AND METHODS This retrospective study included 81,425 patients without congenital heart disease who underwent chest CT. We reviewed the recorded reports and CT images for congenital anomalies of the left BCV including aberrant and supernumerary BCVs. The associated congenital aortic anomalies were assessed. RESULTS Among 73,407 cases at a university hospital, 22 (16 males, 6 females; mean age, 59 years) with aberrant left BCVs were found using keyword research on recorded reports (0.03%). Among 8018 cases at the branch hospital, 5 (4 males, 1 female; mean age, 67 years) with aberrant left BCVs were found using CT image review (0.062%). There were no significant differences in incidences of aberrant left BCV between the two groups. Two cases had double left BCVs. Eleven cases showed high aortic arches. Two cases had the right aortic arch, one case had an incomplete double aortic arch, and one case was associated with coarctation. CONCLUSION Aberrant left BCV on CT examination in adults was extremely rare. Some cases were associated with aortic arch anomalies.
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Affiliation(s)
- Hiroshi Yamamuro
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan.
| | - Tamaki Ichikawa
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Jun Hashimoto
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Shun Ono
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yoshimi Nagata
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Shuichi Kawada
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Makiko Kobayashi
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Jun Koizumi
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Takeo Shibata
- Department of Molecular Life Sciences, Tokai University School of Medicine, 143 Shimokasuya, Isehara, 259-1193, Japan
| | - Yutaka Imai
- Department of Radiology, Tokai University School of Medicine, 259-1193, 143 Shimokasuya, Isehara, 259-1193, Japan
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Goel AN, Reyes C, Mclaughlin S, Wittry M, Fiore AC. Case report. Retroesophageal Left Brachiocephalic Vein in an Infant Without Cardiac Anomalies. PRENATAL CARDIOLOGY 2017. [DOI: 10.1515/pcard-2016-0012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Retroesophageal course of the left brachiocephalic vein is a rare variant seen in patients with congenital heart disease. However, this anomaly without associated cardiac or aortic abnormalities is nearly unheard of, with only one prior case described in the literature. We present an infant with anomalous retroesophageal left brachiocephalic vein that was an incidental finding on computed tomography (CT). We also briefly discuss its embryologic and clinical significance.
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Affiliation(s)
- Alexander N. Goel
- Department of Pediatric Cardiothoracic Surgery, Cardinal Glennon Children’s Hospital, St. Louis, MO, USA 63104, United States of America
| | - Camila Reyes
- Department of Pediatric Cardiothoracic Surgery, Cardinal Glennon Children’s Hospital, St. Louis, MO, USA 63104, United States of America
| | - Shauna Mclaughlin
- Department of Pediatric Cardiothoracic Surgery, Cardinal Glennon Children’s Hospital, St. Louis, MO, USA 63104, United States of America
| | - Mark Wittry
- Department of Cardiac Imaging, St. John’s Mercy Medical Center, St. Louis, MO, USA 63141, United States of America
| | - Andrew C. Fiore
- Department of Pediatric Cardiothoracic Surgery, Cardinal Glennon Children’s Hospital, St. Louis, MO, USA 63104, United States of America
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15
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Srinivasan S, Kannivelu A, Ali SZ, See PLP. Isolated retroaortic left innominate vein in an adult without cardiac or aortic anomalies. Indian J Radiol Imaging 2014; 23:308-9. [PMID: 24604933 PMCID: PMC3932571 DOI: 10.4103/0971-3026.125573] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
- Sivasubramanian Srinivasan
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768 228, Republic of Singapore
| | - Anbalagan Kannivelu
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768 228, Republic of Singapore
| | - Syed Zama Ali
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768 228, Republic of Singapore
| | - Poh Lye Paul See
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768 228, Republic of Singapore
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16
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Iimura A, Oguchi T, Matsuo M, Hayashi S, Moriyama H, Itoh M. Anatomical study of the coexistence of the postaortic left brachiocephalic vein with the postaortic left renal vein with a review of the literature. Okajimas Folia Anat Jpn 2014; 91:73-82. [PMID: 25797460 DOI: 10.2535/ofaj.91.73] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In a student course of gross anatomy dissection at Kanagawa Dental University in 2009, we found an extremely rare case of the coexistence of the postaortic left brachiocephalic vein with the postaortic left renal vein of a 73-year-old Japanese male cadaver. The left brachiocephalic vein passes behind the ascending aorta and connects with the right brachiocephalic vein, and the left renal vein passes behind the abdominal aorta. These two anomalous cases mentioned above have been reported respectively. There have been few reports discussing coexistence of the postaortic left brachiocephalic vein with the postaortic left renal vein. We discuss the anatomical and embryological aspect of this anomaly with reference in the literature.
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Affiliation(s)
- Akira Iimura
- Dental Anatomy Division, Department of Oral Science, Kanagawa Dental University
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Abstract
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 vein Results: 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.
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Affiliation(s)
- Antonio F Corno
- Pediatric and Congenital Cardiac Surgery, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia
| | - Sami A Alahdal
- Pediatric and Congenital Cardiac Surgery, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia
| | - Karuna Moy Das
- Department of Radiology, King Fahad Medical City Riyadh, Kingdom of Saudi Arabia
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Abstract
Anomalies of the innominate vein are uncommon in congenital cardiac disease. We report a case of duplicate innominate veins forming a vascular ring encircling the ascending aorta. We postulate that this vascular ring represents the failure of both a dorsal and ventral precardinal anastomosis to regress.
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Double Precardinal Anastomoses With Interconnecting Venous Plexus Hypothesis in the Embryogenesis of Anomalous Brachiocephalic Veins. J Thorac Imaging 2011; 26:240-6. [DOI: 10.1097/rti.0b013e3181e3583f] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Kulkarni S, Jain S, Kasar P, Garekar S, Joshi S. Retroaortic left innominate vein - Incidence, association with congenital heart defects, embryology, and clinical significance. Ann Pediatr Cardiol 2011; 1:139-41. [PMID: 20300257 PMCID: PMC2840759 DOI: 10.4103/0974-2069.43881] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
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.
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Affiliation(s)
- Snehal Kulkarni
- Pediatric and Congenital Heart Center, Wockhardt Hospital, Mumbai, India
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21
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Nakayama M, Itou T, Abe T, Yoshizumi T. Reconstruction of nonconfluent pulmonary artery using the retroaortic innominate vein for a single ventricle. Gen Thorac Cardiovasc Surg 2011; 59:359-62. [PMID: 21547633 DOI: 10.1007/s11748-010-0691-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 08/18/2010] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Masato Nakayama
- Department of Cardiovascular Surgery, Nagoya Daiichi Red Cross Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya 453-0046, Japan.
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23
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Chen SJ, Liu KL, Chen HY, Chiu IS, Lee WJ, Wu MH, Li YW, Lue HC. Anomalous Brachiocephalic Vein: CT, Embryology, and Clinical Implications. AJR Am J Roentgenol 2005; 184:1235-40. [PMID: 15788602 DOI: 10.2214/ajr.184.4.01841235] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE CT patterns of anomalous brachiocephalic veins are presented with reconsideration of the structure's embryogenesis. CONCLUSION With advancements in central line procedures and corrective cardiac surgery, and the widespread use of noninvasive imaging techniques, the clinical importance of identification of the anomalous brachiocephalic vein is shown.
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Affiliation(s)
- Shyh-Jye Chen
- Department of Medical Imaging and General Examination, National Taiwan University Hospital, Taipei, Taiwan
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24
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Konstantinov IE, Van Arsdell GS, O'Blenes S, Roy N, Campbell A. Retroaortic innominate vein with coarctation of the aorta: surgical repair and embryology review. Ann Thorac Surg 2003; 75:1014-6. [PMID: 12645739 DOI: 10.1016/s0003-4975(02)04333-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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MESH Headings
- Anastomosis, Surgical
- Aorta, Thoracic/embryology
- Aorta, Thoracic/surgery
- Aortic Coarctation/embryology
- Aortic Coarctation/surgery
- Aortic Stenosis, Subvalvular/embryology
- Aortic Stenosis, Subvalvular/surgery
- Blood Vessel Prosthesis Implantation
- Brachiocephalic Veins/abnormalities
- Brachiocephalic Veins/embryology
- Brachiocephalic Veins/surgery
- Echocardiography
- Female
- Heart Defects, Congenital/embryology
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Ventricular/embryology
- Heart Septal Defects, Ventricular/surgery
- Humans
- Infant, Newborn
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Affiliation(s)
- Igor E Konstantinov
- Division of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
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