1
|
Abu Sabha MR, Bairmani ZA, Alfroukh KM, Nassar O, Albakri M. Extensive Deep Vein Thrombosis With Intraabdominal Extension Triggered by Oral Contraceptive Use in a Young Patient With Interrupted Inferior Vena Cava With Azygos Continuation: A Case Report. Cureus 2023; 15:e42690. [PMID: 37649933 PMCID: PMC10465072 DOI: 10.7759/cureus.42690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
Congenital malformations of the inferior vena cava (IVC) are rare and often asymptomatic, typically discovered incidentally during imaging. However, these anomalies can result in circulatory stasis, impede venous return, and serve as predisposing factors for thrombus formation. Here, we present a unique case of a 28-year-old female patient who was found to have interrupted IVC with azygos continuation, an exceedingly rare IVC anomaly, during a work-up of extensive bilateral deep vein thrombosis (DVT) with an intraabdominal extension which was triggered by recent combined oral contraceptive pills (OCP) use. This case highlights the importance of considering vena cava malformations as an underlying cause for extensive DVT, even in the absence of conventional risk factors. Clinicians should be aware of the potential association between congenital vena cava anomalies and thrombotic events, as early recognition and appropriate management are crucial for preventing complications such as pulmonary embolism.
Collapse
Affiliation(s)
- Mosa R Abu Sabha
- Internal Medicine, Faculty of Medicine, Al Quds University, Jerusalem, PSE
| | - Zinah A Bairmani
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, USA
| | | | - Osayd Nassar
- Internal Medicine Department, Al-Ahli Hospital, Hebron, PSE
| | - Mutaz Albakri
- Internal Medicine Department, Hebron University College of Medicine, Hebron, PSE
| |
Collapse
|
2
|
Varotto L, Dotto A, Spigolon L, Spadaro GL, Caprioglio F. Transcatheter secundum atrial septal defect closure using intracardiac echocardiography in adult patient with azygos/hemiazygos continuation of the inferior vena cava. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2023. [DOI: 10.1016/j.ijcchd.2023.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
|
3
|
Dasgupta S, Johnsrude C. Non-fluoroscopic Techniques for Catheter Ablation of Typical Atrioventricular Nodal Re-entry Tachycardia in a Pediatric Patient with Atypical Venous Anatomy. J Innov Card Rhythm Manag 2022; 13:5131-5134. [PMID: 36072444 PMCID: PMC9436404 DOI: 10.19102/icrm.2022.130802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/27/2022] [Indexed: 11/07/2022] Open
Abstract
Catheter ablation of the slow pathway to the atrioventricular node is generally a safe and effective treatment for atrioventricular nodal re-entry tachycardia (AVNRT). However, congenital anomalies of the inferior vena cava and superior draining veins can limit traditional catheter approaches to the right heart from femoral venous access and distort local anatomy within the triangle of Koch, necessitating alternative electrophysiology (EP) mapping and ablation strategies. Despite the widespread availability of non-fluoroscopic 3-dimensional imaging systems, many providers still rely on venography to describe unusual cardiovascular anatomy and fluoroscopy to position EP catheters when mapping and ablating the slow pathway. Herein, we report our experience with a pediatric patient with inducible AVNRT and atypical venous anatomy in whom slow pathway ablation was performed successfully without the use of fluoroscopy. In addition, we describe the modification of a novel mapping technique for targeting the slow pathway for ablation.
Collapse
Affiliation(s)
- Soham Dasgupta
- Division of Pediatric and Adult Congenital Electrophysiology, Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA,Address correspondence to: Soham Dasgupta, MD, Division of Pediatric and Adult Congenital Electrophysiology, Department of Pediatrics, Norton Children’s Hospital, University of Louisville, 231 E. Chestnut St., Suite 113, Louisville, KY 40202, USA.
| | - Christopher Johnsrude
- Division of Pediatric and Adult Congenital Electrophysiology, Department of Pediatrics, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| |
Collapse
|
4
|
Rizzo G, Lu JLA, Mappa I. Should we include bicaval view in the study of the fetal heart? JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:803-804. [PMID: 35834666 DOI: 10.1002/jcu.23208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Giuseppe Rizzo
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Jia Li Angela Lu
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| | - Ilenia Mappa
- Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Rome, Italy
| |
Collapse
|
5
|
Yokoyama Y, Aiba T, Miyamoto K, Kanzaki H, Ueda N, Nakajima K, Kamakura T, Wada M, Yamagata K, Ishibashi K, Inoue Y, Nagase S, Noda T, Izumi C, Kusano K. Pulmonary Vein Isolation and Pacemaker Implantation in a Patient with Dextrocardia Situs Inversus. Int Heart J 2021; 62:927-931. [PMID: 34276015 DOI: 10.1536/ihj.20-804] [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: 11/18/2022]
Abstract
A 70-year-old female with dextrocardia with situs inversus (DSI) totalis and inferior vena cava occlusion underwent radiofrequency catheter ablation because she had symptomatic paroxysmal atrial fibrillation (AF). Careful preoperative examination made successful pulmonary vein isolation through the left jugular vein approach. One-year later, however, AF recurred, and symptomatic sinus bradycardia or junctional bradycardia often occurred. Then, the pacemaker was implanted. We here reported a rare case of congenital abnormality, DSI with inferior vena cava occlusion who had undergone successful pulmonary vein isolation and pacemaker implantation without any complications.
Collapse
Affiliation(s)
- Yasuhiro Yokoyama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hideaki Kanzaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenzaburo Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kenichiro Yamagata
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| |
Collapse
|
6
|
Agrawal G, Das A, Gupta G. An unusual case of uninterrupted inferior vena cava with accessory hemizygous channel: An incidental finding in a child. Ann Card Anaesth 2020; 23:512-514. [PMID: 33109815 PMCID: PMC7879915 DOI: 10.4103/aca.aca_117_19] [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] [Indexed: 11/05/2022] Open
Abstract
Azygos or hemizygous continuation of inferior vena cava (IVC) is diagnosed in the presence of intrahepatic interruption of IVC. We report a case of a 4-year-old, male child presenting with a history of poor weight gain. A detailed evaluation of the child revealed a diagnosis of hemizygous continuation of uninterrupted, but severely obstructed, IVC. This incidental finding has rarely been reported in the literature.
Collapse
Affiliation(s)
- Gaurav Agrawal
- Department of Pediatric Cardiology, BL Kapur Super Speciality Hospital, New Delhi, India
| | - Anupam Das
- Department of Cardio-thoracic and Vascular Surgery, BL Kapur Super Speciality Hospital, New Delhi, India
| | - Gaurav Gupta
- Department of Cardio-thoracic and Vascular Surgery, BL Kapur Super Speciality Hospital, New Delhi, India
| |
Collapse
|
7
|
Kwon SH, Shin SY. Incidental adult polysplenia with situs inversus, interrupted inferior vena cava with azygos continuation, patent ductus arteriosus, and aortic branches variations: a case report. J Thorac Dis 2018; 10:E138-E141. [PMID: 29607204 DOI: 10.21037/jtd.2018.01.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Polysplenia syndrome is a rare condition (about 2.5:100,000 live births) wherein a person has two or more spleens with accompanying various thoracic and abdominal organ abnormalities. Polysplenia is usually associated with situs ambiguous, while polysplenia with situs inversus is very rare. Herein, we report a rare case of incidentally found polysplenia syndrome combined with situs inversus in a 59-year-old female who also had an interrupted inferior vena cava (IVC) with azygos continuation, patent ductus arteriosus (PDA), and variations in the aortic arch branches. An aberrant left subclavian artery with Kommerell's diverticulum and a large aneurysm in the non-aberrant, proximal-right subclavian artery were also noted.
Collapse
Affiliation(s)
- Se Hwan Kwon
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - So Youn Shin
- Department of Radiology, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| |
Collapse
|
8
|
Liu Y, Guo D, Li J, Zhang X, He J, Huang M, Dai J, Cai H. Radiological features of azygos and hemiazygos continuation of inferior vena cava: A case report. Medicine (Baltimore) 2018; 97:e0546. [PMID: 29703035 PMCID: PMC5944491 DOI: 10.1097/md.0000000000010546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Azygos and hemiazygos continuation of the inferior vena cava (IVC) is uncommon. It is rare especially when it is not associated with congenital heart disease or deep venous thrombosis. PATIENT CONCERNS We report an interesting case of an interstitial lung disease with an interrupted IVC with azygous and hemiazygos continuation. A 67-year-old man suffered from cough and shortness of breath. DIAGNOSES Computed tomography revealed absence of the hepatic segment of the IVC with azygos and hemiazygos continuation. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature and viscera. The diagnosis of azygos and hemiazygos continuation of IVC was made by inferior venacavography. INTERVENTIONS There was no significant association between interstitial lung disease and expanded azygos and hemiazygos veins. The patient was treated with corticosteroids. OUTCOMES After 6 months of follow-up, the patient was asymptomatic. LESSONS It is important to recognize the enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space to avoid misdiagnosis as a right-sided paratracheal mass or retrocrural adenopathy.
Collapse
Affiliation(s)
| | - Dan Guo
- Department of General Medicine
| | | | - Xuebin Zhang
- Department of Radiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Jian He
- Department of Radiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | | | | | | |
Collapse
|
9
|
Wu LH, Xie HN, Paladini D, Zheng J, Du L, Lin MF. Azygos Vein Z Scores in Healthy Fetuses and Fetuses With Venous Malformations Related to the Azygos Vein. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2563-2574. [PMID: 27738290 DOI: 10.7863/ultra.16.01087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/20/2016] [Accepted: 03/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To establish fetal azygos vein and descending aorta sonographic Z score formulas based on femur length and gestational age and to determine the value of azygos vein diameter variation for potential use in the diagnosis of fetal venous malformations related to the azygos vein. METHODS A total of 452 healthy singleton fetuses and 25 fetuses with venous malformations related to the azygos vein underwent prenatal sonography in this retrospective study. Azygos vein and descending aorta diameters were measured offline after spatiotemporal image correlation volume acquisition. Normal azygos vein and descending aorta Z score formulas were constructed for these measurements based on femur length by performing standard regression analysis followed by weighted regression of absolute residual values. The azygos vein-to-descending aorta ratio was calculated. Three parameters were compared between venous malformations related to the azygos vein and healthy fetuses. RESULTS Azygos vein and descending aorta Z score formulas were constructed. Both showed a positive linear correlation with femur length (r = 0.79 and 0.90, respectively; P < .01) and gestational age (r = 0.79 and 0.91; P < .01). The azygos vein Z scores and azygos vein-to-descending aorta ratios of fetuses with malformations were significantly higher than those of healthy fetuses (P < .01). In the abnormal group, 96.0% of azygos vein Z scores (24 of 25) were greater than ±2, and 96.0% of azygos vein-to-descending aorta ratios (24 of 25) were greater than the 95% confidence interval. CONCLUSIONS The azygos vein Z score formulas we developed can provide a quantitative basis for prenatal screening of venous malformations related to the azygos vein. Azygos vein dilatation and an abnormal azygos vein-to-descending aorta ratio may contribute to increasing the recognition of venous malformations involving the azygos vein.
Collapse
Affiliation(s)
- Li-Hong Wu
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Dario Paladini
- Department of Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liu Du
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mei-Fang Lin
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
10
|
Rathakrishnan SS, Kaliappan T, Gopalan R. Beware of Venous Anomalies in Young Patients with Sick Sinus Syndrome: A Report of Two Cases of Sick Sinus Syndrome with Systemic Venous Anomalies. Heart Views 2016; 16:107-10. [PMID: 27326354 PMCID: PMC4590181 DOI: 10.4103/1995-705x.164458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report two young patients with symptomatic sick sinus syndrome admitted for permanent pacemaker implantation (PPI). On evaluation with echocardiography, one of them was found to have persistent left superior vena cava and venography showed absent right superior vena cava also. He underwent PPI with leads inserted via left superior vena cava, coronary sinus, right atrium and right ventricle. The other patient was incidentally found to have interrupted inferior vena cava with azygos continuation while being planned for temporary pacemaker implantation. She underwent successful PPI. We would like to stress the importance of having a high suspicion for these systemic venous anomalies in patients presenting with sick sinus syndrome especially at young age. If we could diagnose preoperatively, we can avoid on table surprises.
Collapse
Affiliation(s)
| | - Tamilarasu Kaliappan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajendiran Gopalan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| |
Collapse
|
11
|
Vasanth Kumar A, Anirudh Kumar A, Hussain A, Sameeraja V. An uncommon encounter during temporary pacemaker implantation - A double inferior vena cava. Indian Heart J 2016; 68 Suppl 2:S216-S217. [PMID: 27751293 PMCID: PMC5067780 DOI: 10.1016/j.ihj.2016.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/27/2015] [Accepted: 01/10/2016] [Indexed: 11/07/2022] Open
Abstract
Double inferior vena cavae (IVC) is a congenital variation caused by an unusual embryological development of the IVC. We report an incidental finding of infrarenal double IVC in a 70-year-old female.
Collapse
Affiliation(s)
- A Vasanth Kumar
- Consultant Cardiologist, Sri VijayaDurga Cardiac Centre, Kurnool, Andhra Pradesh, India.
| | - A Anirudh Kumar
- Resident, Sri VijayaDurga Cardiac Centre, Kurnool, Andhra Pradesh, India
| | - Anwar Hussain
- Consultant Radiologist, Sri VijayaDurga Cardiac Centre, Kurnool, Andhra Pradesh, India
| | - Vaddera Sameeraja
- Consultant Physician, Sri VijayaDurga Cardiac Centre, Kurnool, Andhra Pradesh, India
| |
Collapse
|
12
|
Odedra A, Farrugia M, Babiker Z. An unusual cause for a relatively common radiographic abnormality. BMJ Case Rep 2014; 2014:bcr-2014-204299. [PMID: 25540206 DOI: 10.1136/bcr-2014-204299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 59-year-old Indian woman presented to the respiratory clinic with chest pains, long-standing swallowing difficulties and a chest radiograph, which was reported as showing a shadow in the right paratracheal region. A CT scan was obtained and was reported as demonstrating a right-sided paratracheal lymph node and varicosities adjacent to the inferior vena cava. Histology from an endobronchial ultrasound-guided biopsy revealed a heavily blood-stained sample but showed no evidence of granulomas or malignancy. Subsequently, the images were reviewed, with the conclusion that they were actually of an engorged azygos vein compressing the oesophagus. MRI confirmed the absence of mediastinal lymphadenopathy and the presence of a prominent hemiazygos vein compressing the oesophagus. This case highlights the importance of including anatomical abnormalities in the differential diagnosis and reassessing patients when the history and investigations do not correlate.
Collapse
Affiliation(s)
- Anand Odedra
- Department of Infection and Immunity, Barts Health Trust, London, UK
| | - Mark Farrugia
- Radiology Department, Barts Health Trust, London, UK
| | - Zahir Babiker
- Department of Infection, Barts Health NHS Trust, London, UK
| |
Collapse
|
13
|
Giang DTC, Rajeesh G, Vaidyanathan B. Prenatal diagnosis of isolated interrupted inferior vena cava with azygos continuation to superior vena cava. Ann Pediatr Cardiol 2014; 7:49-51. [PMID: 24701087 PMCID: PMC3959062 DOI: 10.4103/0974-2069.126558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Absence of inferior vena cava is an uncommon congenital abnormality. It is usually associated with other structural anomalies, typically left isomerism. We report a case of interrupted inferior vena cava with azygos continuation diagnosed as an isolated finding during routine prenatal ultrasound scan, confirmed by post-natal echocardiography. Detailed ultrasound examination of the fetal anatomy failed to demonstrate other anomalies. The neonatal course of this fetus was uneventful.
Collapse
Affiliation(s)
- Do Thi Cam Giang
- Fetal Cardiology Unit, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Gayatri Rajeesh
- Fetal Cardiology Unit, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Balu Vaidyanathan
- Fetal Cardiology Unit, Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| |
Collapse
|
14
|
Saito T, Watanabe M, Kojima T, Matsumura T, Fujita H, Kiyosue A, Takahashi M, Takeda N, Maemura K, Yamashita H, Hirata Y, Komatsu S, Ohtomo K, Nagai R. Successful blood sampling through azygos continuation with interrupted inferior vena cava. A case report and review of the literature. Int Heart J 2011; 52:327-30. [PMID: 22008446 DOI: 10.1536/ihj.52.327] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Interrupted inferior vena cava (IVC) with azygos continuation is a rare congenital anomaly, and is frequently associated with other cardiovascular malformations and situs anomalies, such as left isomerism. These patients usually develop deep vein thrombosis (DVT), and asymptomatic patients above 60 years of age are very rare. Here we report a case of interrupted IVC which we diagnosed in a 72-year-old woman. She was admitted to our hospital suffering from heart failure and supraventricular tachycardia. Echocardiography detected secundum atrial septal defect (ASD). An abnormal paravertebral pleural line on the chest X-rays indicated the existence of venous anomaly. Anatomical images obtained by Multidetector Computed Tomography (MDCT) helped us to successfully perform right heart catheterization procedures through azygos continuation including blood sampling from pulmonary veins. Even in elderly patients, a careful examination of chest X-rays can indicate undiagnosed venous anomalies; thus, it is critically important before planning surgical or interventional procedures.
Collapse
Affiliation(s)
- Tetsuya Saito
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Cordina RL, Celermajer DS, McGuire MA. Systemic venous anatomy in congenital heart disease: implications for electrophysiologic testing and catheter ablation. J Interv Card Electrophysiol 2011; 33:143-9. [PMID: 22015428 DOI: 10.1007/s10840-011-9624-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 09/04/2011] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiac arrhythmias are a significant problem in patients with congenital heart disease. Many patients with congenital heart disease have abnormal systemic venous anatomy which can complicate electrophysiologic testing, catheter ablation and pacemaker and defibrillator implantation. We reviewed the systemic venous anatomy in a cohort of patients undergoing electrophysiologic testing and catheter ablation. METHODS AND RESULTS We reviewed all electrophysiologic studies performed in patients with adult congenital heart disease (n = 80) at our institution between January 1998 and October 2009. Ten patients (13%) had a congenital systemic venous anomaly. Of these, seven (9%) had a left superior vena cava and four (5%) had infrahepatic interruption of the inferior vena cava (two had both anomalies). One patient's inferior vena cava was connected to a left-sided atrium; she had right atrial isomerism. In four patients (40%), systemic venous abnormalities were discovered at the time of electrophysiologic testing. CONCLUSIONS Systemic venous anomalies occur frequently in the congenital heart disease population and may complicate electrophysiologic testing and catheter ablation. Pre-procedural imaging may assist in facilitating a successful procedure.
Collapse
|
16
|
Infrahepatic caudal/inferior vena cava interruption with azygos/hemiazygos continuation. Vascular anomaly in swine. Radiol Oncol 2010; 44:149-52. [PMID: 22933907 PMCID: PMC3423700 DOI: 10.2478/v10019-010-0029-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Accepted: 04/22/2010] [Indexed: 11/29/2022] Open
Abstract
Background Swine are commonly used as a model to study congenital cardiovascular defects that occur in humans and these models have been both spontaneous and experimentally induced. Ventricular septal defect, patent ductus arteriosus, and atrial septal defect (ASD) are examples of experimentally induced models. Absence of caudal/inferior vena cava (CVC/IVC) with azygos/hemiazygos continuation is an uncommon vascular anomaly. Case report The vascular anomaly presented in this case report was an incidental finding on a pig that was evaluated for experimental percutaneous atrial septal defect creation and its closure using a percutaneous femoral vein approach. Absence of CVC/IVC was confirmed by venography and necropsy. Conclusions To the best of the investigators knowledge, this is the first report of absence of CVC/IVC with azygos/hemiazygos continuation in the swine.
Collapse
|
17
|
Polysplenia and interrupted inferior vena cava with azygos continuation: 64-slice multidetector row computed tomography findings. Pediatr Cardiol 2010; 31:927-8. [PMID: 20490477 DOI: 10.1007/s00246-010-9727-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 05/05/2010] [Indexed: 10/19/2022]
|
18
|
Interrupted inferior vena cava and partial anomalous pulmonary venous return with atrial septal defect in a 38-year-old adult: a case report. CASES JOURNAL 2009; 2:7346. [PMID: 19829946 PMCID: PMC2740028 DOI: 10.4076/1757-1626-2-7346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2009] [Accepted: 06/18/2009] [Indexed: 11/15/2022]
Abstract
We present a woman having congenital anomalies of the inferior vena cava and partial anomalous pulmonary venous return from the right lung with atrial septal defect in a 38-year-old. Congenital anomalies of inferior vena cava are rare. They are seen more often in young males. If there are not other anomalies, they are latent for a long time. Peripheral venous thrombosis, chronic venous insufficiency, dyspnea and fatigue are often the first symptoms of these anomalies. Surgical repair of atrial septal defect with partial anomalous pulmonary venous return include provision of durably unobstructed systemic and pulmonary venous pathways, closure of the atrial septal defect, and avoidance of arrhythmias. The diagnosis has been determined by compression ultrasonography with color doppler assessment, multidetector computed tomography angiography and echocardiography.
Collapse
|
19
|
Ernst S, Chun JKR, Koektuerk B, Kuck KH. Magnetic Navigation and Catheter Ablation of Right Atrial Ectopic Tachycardia in the Presence of a Hemi-Azygos Continuation: A Magnetic Navigation Case Using 3D Electroanatomical Mapping. J Cardiovasc Electrophysiol 2009; 20:99-102. [PMID: 18662184 DOI: 10.1111/j.1540-8167.2008.01254.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Sabine Ernst
- National Heart and Lung Institute, Imperial College, Royal Brompton and Harefield Hospital, London, UK.
| | | | | | | |
Collapse
|
20
|
Oruganti SS, Jariwala P, Taggarse AK, Mishra RC. Unusual venacaval anomalies in a patient with atrial septal defect. Asian Cardiovasc Thorac Ann 2008; 16:492-4. [PMID: 18984762 DOI: 10.1177/021849230801600614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
An unusual systemic venous drainage pattern was found in a 30-year-old man with ostium secundum atrial septal defect and pulmonary stenosis. He had the rare association of absent right superior vena cava, persistent left superior vena cava draining into the coronary sinus, and a left-sided inferior vena cava draining into a left superior vena cava through the hemiazygous vein.
Collapse
Affiliation(s)
- Sai S Oruganti
- Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad-500 082, Andhra Pradesh, India.
| | | | | | | |
Collapse
|
21
|
Gutiérrez Abad C, Vara Castrodeza A, Centeno Malfaz F, Alcalde Martín C. Vena hemiácigos persistente y ausencia de vena cava inferior intrahepática. ¿Un hallazgo casual? An Pediatr (Barc) 2008; 68:412-4. [DOI: 10.1157/13118080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
22
|
Martín-Malagón A, Bravo A, Arteaga I, Rodríguez L, Estévez F, Alarcó A. Ivor Lewis esophagectomy in a patient with enlarged azygos vein: a lesson to learn. Ann Thorac Surg 2008; 85:326-8. [PMID: 18154839 DOI: 10.1016/j.athoracsur.2007.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2007] [Revised: 06/07/2007] [Accepted: 06/13/2007] [Indexed: 10/22/2022]
Abstract
We report the case of a 62-year-old patient with congenital interruption of the inferior vena cava and azygos continuation who required transthoracic esophagectomy to remove a tumor in the middle esophagus. The consequences of dividing an enlarged azygos vein in this kind of patient are reported and discussed.
Collapse
Affiliation(s)
- Antonio Martín-Malagón
- Department of General Surgery, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Canary Islands, Spain.
| | | | | | | | | | | |
Collapse
|
23
|
Gil RJ, Pérez AM, Arias JB, Pascual FB, Romero ES. Agenesis of the inferior vena cava associated with lower extremities and pelvic venous thrombosis. J Vasc Surg 2006; 44:1114-6. [PMID: 17098553 DOI: 10.1016/j.jvs.2006.06.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 06/25/2006] [Indexed: 11/21/2022]
Abstract
The absence of the inferior vena cava is an uncommon congenital anomaly and can be misdiagnosed. We report a 14-year-old boy initially admitted as a result of a painful abdominal mass; after admission, he experienced a deep venous thrombosis in his left leg. Subsequent evaluation revealed the congenital absence of the entire inferior vena cava, with a cluster of thrombosed collateral veins in his right pelvis, corresponding to the abdominal mass. The recognition of this anomaly may be helpful in the event of differential diagnosis in retroperitoneal masses. In young patients with idiopathic deep venous thrombosis, an inferior vena cava anomaly should be considered.
Collapse
Affiliation(s)
- Roberto Jiménez Gil
- Servicio de Angiología y Cirugía Vascular, Hospital General Universitario de Alicante, Alicante, Spain.
| | | | | | | | | |
Collapse
|
24
|
Mukerji S, Khunnawat C, Kantipudi S, Khasnis A, Sankaran S, Thakur RK, Jongnarangsin K. 3-Dimensional Mapping and Radiofrequency Ablation of Atrial Flutter in a Patient with Interrupted Inferior Vena Cava. J Interv Card Electrophysiol 2005; 14:107-9. [PMID: 16374558 DOI: 10.1007/s10840-005-4512-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 08/22/2005] [Indexed: 10/25/2022]
Abstract
The presence of isolated interrupted inferior vena cava (IVC) is very rare. Though the occurrence of typical atrial flutter in this setting has recently been described, the use of 3-dimensional activation mapping to aid the management of such patients has not yet been described. We report the successful ablation of this arrhythmia in a 63-year-old woman using the superior route through the internal jugular vein with the help of a mapping system.
Collapse
Affiliation(s)
- Siddharth Mukerji
- Division of Cardiology, Michigan State University, East Lansing, Michigan, USA
| | | | | | | | | | | | | |
Collapse
|