Localized reentry in the superior vena cava giving rise to an atypical right atrial flutter: Insights from an analysis of two cases

Sinus venosus atrial septal defect (ASD) is usually associated with partial anomalous pulmonary venous return (PAPVR) of the right pulmonary veins to the superior vena cava (SVC), or to the SVC-right atrial junction. Standard procedure for repair of this defect is a patch roofing of the sinus venosus ASD and rerouting of pulmonary veins. However, the presence of SVC stenosis is a complication of this technique, and SVC augmentation is necessary in some cases. We present a simple technique for concomitant closure of sinus venosus ASD associated with PAPVR and augmentation of the SVC with a single autologous pericardial patch.

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P649 Before and after: sinus venosus atrial septal defect

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.331 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

I Marco Clement ◽

R Eiros ◽

R Dalmau ◽

T Lopez ◽

G Guzman ◽

...

Keyword(s):

Atrial Septal Defect ◽

Left Atrium ◽

Atrial Flutter ◽

Superior Vena Cava ◽

Right Atrium ◽

Septal Defect ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

The Right

Abstract Introduction The diagnosis of sinus venosus atrial septal defect (SVASD) is complex and requires special imaging. Surgery is the conventional treatment; however, transcatheter repair may become an attractive option. Case report A 60 year-old woman was admitted to the cardiology department with several episodes of paroxysmal atrial flutter, atrial fibrillation and atrioventricular nodal reentrant tachycardia. She reported a 10-year history of occasional palpitations which had not been studied. A transthoracic echocardiography revealed severe right ventricle dilatation and moderate dysfunction. Right volume overload appeared to be secondary to a superior SVASD with partial anomalous pulmonary venous drainage. A transesophageal echocardiography confirmed the diagnosis revealing a large SVASD of 16x12 mm (Figure A) with left-right shunt (Qp/Qs 2,2) and two right pulmonary veins draining into the right superior vena cava. Additionally, it demonstrated coronary sinus dilatation secondary to persistent left superior vena cava. CMR and cardiac CT showed right superior and middle pulmonary veins draining into the right superior vena cava 18 mm above the septal defect (Figures B and C). After discussion in clinical session, a percutaneous approach was planned to correct the septal defect and anomalous pulmonary drainage. For this purpose, anatomical data obtained from CMR and CT was needed to plan the procedure. During the intervention two stents graft were deployed in the right superior vena cava. The distal stent was flared at the septal defect level so as to occlude it while redirecting the anomalous pulmonary venous flow to the left atrium (Figure D). Control CT confirmed the complete occlusion of the SVASD without residual communication from pulmonary veins to the right superior vena cava or the right atrium (Figure E). Anomalous right superior and middle pulmonary veins drained into the left atrium below the stents. Transthoracic echocardiographies showed progressive reduction of right atrium and ventricle dilatation. The patient also underwent successful ablation of atrial flutter and intranodal tachycardia. She is currently asymptomatic, without dyspnea or arrhythmic recurrences. Conclusions In this case, multimodality imaging played a key role in every stage of the clinical process. First, it provided the diagnosis and enabled an accurate understanding of the patient’s anatomy, particularly of the anomalous pulmonary venous connections. Secondly, it allowed a transcatheter approach by supplying essential information to guide the procedure. Finally, it assessed the effectiveness of the intervention and the improvement in cardiac hemodynamics during follow-up. Abstract P649 Figure.

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Sinus Node Injury as a Result of Superior Vena Cava Isolation during Catheter Ablation for Atrial Fibrillation and Atrial Flutter

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2010.02903.x ◽

2010 ◽

Vol 34 (2) ◽

pp. 163-170 ◽

Cited By ~ 17

Author(s):

GANG CHEN ◽

JIAN ZENG DONG ◽

XING PENG LIU ◽

XIN YONG ZHANG ◽

DE YONG LONG ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Atrial Flutter ◽

Superior Vena Cava ◽

Superior Vena ◽

Sinus Node ◽

Vena Cava

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Recurrent cardiac hydatid cyst located near the root of the superior vena cava and the interatrial septum: a case report

10.36811/jcshd.2022.110023 ◽

2022 ◽

pp. 1-4

Author(s):

Redha Lakehal ◽

Farid Aymer ◽

Soumaya Bendjaballah ◽

Rabah Daoud ◽

Khaled Khacha ◽

...

Keyword(s):

Hydatid Cyst ◽

Facial Paralysis ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Lower Lobe ◽

Lateral Wall ◽

Right Atrial ◽

Risk Of Rupture ◽

The Right

Introduction: Cardiac localization of hydatid disease is rare (<3%) even in endemic countries. Affection characterized by a long functional tolerance and a large clinical and paraclinical polymorphism. Serious cardiac hydatitosis because of the risk of rupture requiring urgent surgery. The diagnosis is based on serology and echocardiography. The aim of this work is to show a case of recurrent cardiac hydatid cyst discovered incidentally during a facial paralysis assessment. Methods: We report the observation of a 26-year-old woman operated on in 2012 for pericardial hydatid cyst presenting a cardiac hydatid cyst located near the abutment of the SCV discovered incidentally during an exploration for left facial paralysis: NYHA stage II dyspnea. Chest x-ray: CTI at 0.48. ECG: RSR. Echocardiography: Image of cystic appearance at the level of the abutment of the SVC. SAPP: 38 mmhg, EF: 65%. Thoracic scan: 30/27 mm cardiac hydatid cyst bulging the lateral wall of the right atrium and the trunk of the right pulmonary artery with fissured cardiac hydatid cyst of the apical segment of the right lung of the right lower lobe with multiple bilateral intra parenchymal and sub pleural nodules. The patient was operated on under CPB. Intraoperative exploration: Presence of a hard and whitish mass, about 03 / 03cm developed in the full right atrial wall opposite the entrance to the superior vena cava. Procedure: Resection of the mass removing the roof of the LA, the AIS and the wall of the RA with reconstruction of the roof of the RA by patch in Dacron and reconstruction of the IAS and the wall of the RA by a single patch in Dacron. Results: The postoperative suites were simple. Conclusion: The hydatid cyst is still a real endemic in Algeria, the cardiac location is rare but serious and can constitute a real surgical emergency, hence the importance of prevention. Keywords: Hydatid cyst of the heart; Recurrence; Surgery; Cardiopulmonary Bypass; Prevention

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Experimental cardiac tamponade: correlation of pressure, flow velocity, and echocardiographic changes

Journal of Applied Physiology ◽

10.1152/jappl.1990.69.3.924 ◽

1990 ◽

Vol 69 (3) ◽

pp. 924-931 ◽

Cited By ~ 2

Author(s):

M. L. Cohen

Keyword(s):

Cardiac Tamponade ◽

Flow Velocity ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Atrial Pressure ◽

Right Atrial ◽

Right Atrial Pressure ◽

Diastolic Flow ◽

Ventricular Filling

Seven episodes of experimental cardiac tamponade were induced in five anesthetized closed-chest dogs. Simultaneous pericardial and intracavitary pressures were synchronized with superior vena caval and transvalvular pulsed-Doppler flow tracings. The earliest indication of tamponade was the development of a negative transmural right atrial pressure that occurred during early ventricular diastole and was associated with echocardiographic evidence of right atrial collapse. This was also associated with reversal of diastolic flow in the superior vena cava and with diminished early diastolic flow velocity across the tricuspid as well as the mitral valve. During more advanced cardiac tamponade, the transmural right atrial pressure became negative during both early and late ventricular diastole as well as during isovolumic ventricular systole. This was associated with a disappearance of early diastolic ventricular filling and right ventricular diastolic collapse as observed on two-dimensional echocardiography. In hypotensive cardiac tamponade (cardiac output diminished by 70%), the decreased transmural right atrial pressure that developed during ventricular systole was accompanied by diminished antegrade flow in the superior vena cava. In advanced and hypotensive tamponade, ventricular filling occurred mainly during atrial contraction.

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Interatrial shunt for chronic pulmonary hypertension: differential impact of low-flow vs. high-flow shunting

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.00496.2008 ◽

2009 ◽

Vol 296 (3) ◽

pp. H639-H644 ◽

Cited By ~ 17

Author(s):

Andreas Zierer ◽

Spencer J. Melby ◽

Rochus K. Voeller ◽

Marc R. Moon

Keyword(s):

Pulmonary Hypertension ◽

Cardiac Output ◽

Superior Vena Cava ◽

Diastolic Pressure ◽

Superior Vena ◽

Vena Cava ◽

High Flow ◽

Low Flow ◽

Right Atrial ◽

Chronic Pulmonary Hypertension

The purpose of the present study was to determine for the first time the qualitative and quantitative impact of varying degrees of interatrial shunting on right heart dynamics and systemic perfusion in subjects with chronic pulmonary hypertension (CPH). Eight dogs underwent 3 mo of progressive pulmonary artery banding, following which right atrial and ventricular end-systolic and end-diastolic pressure-volume relations were calculated using conductance catheters. An 8-mm shunt prosthesis was inserted between the superior vena cava and left atrium, yielding a controlled model of atrial septostomy. Data were obtained 1) preshunt or “CPH”; 2) “Low-Flow” shunt; and 3) “High-Flow” shunt (occluding superior vena cava forcing all flow through the shunt). With progressive shunting, right ventricular pressure fell from 72 ± 19 mmHg (CPH) to 54 ± 17 mmHg (Low-Flow) and 47 ± 17 mmHg (High-Flow) ( P < 0.001). Cardiac output increased from 1.5 ± 0.3 l/min at CPH to 1.8 ± 0.4 l/min at Low-Flow (286 ± 105 ml/min, 15% of cardiac output; P < 0.001), but returned to 1.6 ± 0.3 l/min at High-Flow (466 ± 172 ml/min, 29% of cardiac output; P = 0.008 vs. Low-Flow, P = 0.21 vs. CPH). There was a modest rise in systemic oxygen delivery from 252 ± 46 ml/min at CPH to 276 ± 50 ml/min at Low-Flow ( P = 0.07), but substantial fall to 222 ± 50 ml/min at High-Flow ( P = 0.005 vs. CPH, P < 0.001 vs. Low-Flow). With progressive shunting, bichamber contractility did not change ( P = 0.98), but the slope of the right atrial end-diastolic pressure volume relation decreased ( P < 0.04), consistent with improved compliance. This study demonstrated that Low-Flow interatrial shunting consistently improved right atrial mechanics and systemic perfusion in subjects with CPH, while High-Flow exceeded an “ideal shunt fraction”.

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