Right-to-left shunt through the cardiac veins after the Fontan procedure

2000 ◽  
Vol 10 (4) ◽  
pp. 416-418 ◽  
Author(s):  
Hideki Uemura ◽  
Toshikatsu Yagihara ◽  
Osamu Monta
Keyword(s):  
Coronary Sinus ◽  
Fontan Procedure ◽  
The Other ◽  
Caval Vein ◽  
Postoperative Course ◽  
Superior Caval Vein ◽  
Cardiac Veins

AbstractWe found right-to-left shunts through the cardiac veins postoperatively in 2 patients who had undergone the Fontan procedure. In one of the patients, channels were present through the cardiac veins independent of the coronary sinus. In the other patient, an atretic orifice for the coronary sinus, coupled with a persistent left-sided superior caval vein, complicated the postoperative course.

Slow pathway cryoablation in a child with absent right superior caval vein and persistent left superior caval vein draining into the coronary sinus

2015 ◽  
Vol 178 ◽  
pp. 178-180
Author(s):  
Alfredo Di Pino ◽  
Elio Caruso ◽  
Placido Gitto ◽  
Luca Costanzo ◽  
Salvatore Patanè ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Slow Pathway ◽  
Caval Vein ◽  
Superior Caval Vein

Bidirectional coronary venous return in the partial unroofed coronary sinus syndrome complicated by coronary sinus orifice atresia

2020 ◽  
Vol 30 (4) ◽  
pp. 582-584 ◽  
Author(s):  
Dai Asada ◽  
Hisato Ito
Keyword(s):  
Coronary Sinus ◽  
Venous Return ◽  
Paradoxical Embolism ◽  
Pressure Balance ◽  
Caval Vein ◽  
Unroofed Coronary Sinus ◽  
Superior Caval Vein ◽  
Systemic Vein ◽  
Coronary Sinus Orifice Atresia ◽  
Unroofed Coronary Sinus Syndrome

AbstractUnroofed coronary sinus syndrome complicated by coronary sinus orifice atresia is a rare congenital anomaly. There are two alternate exits for coronary venous return: unroofed coronary sinus and persistent left superior caval vein. The coronary venous direction could be bidirectional depending on the pressure balance between the left atrium and the systemic vein. This anomaly has the risk of heart failure, paradoxical embolism, and cyanosis.

Right superior caval vein draining into the left atrium—diagnosis by color flow mapping

1995 ◽  
Vol 5 (4) ◽  
pp. 345-349 ◽  
Author(s):  
Luis E. Alday ◽  
Hector Maisuls ◽  
Roberto De Rossi
Keyword(s):  
Left Atrium ◽  
Clinical Findings ◽  
The Other ◽  
Flow Mapping ◽  
Caval Vein ◽  
Color Flow ◽  
Superior Caval Vein ◽  
Color Flow Mapping ◽  
Excellent Method ◽  
The Right

AbstractWe report two female patients, one aged four years and the other a newborn, referred for evaluation of cyanosis with otherwise normal cardiovascular findings, who proved to have the right superior caval vein draining into the morphologically left atrium. In both patients, the diagnosis was made by color flow mapping. The older child underwent catheterization and subsequent successful surgical correction. A right superior caval vein draining into the left atrium, although very rare, should always be considered a diagnostic possibility in the presence of cyanosis and normal clinical findings. Color flow mapping is an excellent method with which to make the diagnosis.

Severe pulmonary hypertension secondary to a parachute-like mitral valve, with the left superior caval vein draining into the coronary sinus, in a girl with Turner's syndrome

2003 ◽  
Vol 13 (4) ◽  
pp. 364-366 ◽  
Author(s):  
Marc van Heerde ◽  
Jaroslav Hruda ◽  
Mark G. Hazekamp
Keyword(s):  
Pulmonary Hypertension ◽  
Mitral Valve ◽  
Coronary Sinus ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
Turner's Syndrome ◽  
Turner’S Syndrome ◽  
Caval Vein ◽  
Superior Caval Vein

A 17-year-old girl with Turner's syndrome underwent two cardiac operations due to severe mitral stenosis with pulmonary hypertension, caused by a parachute-like mitral valve. The anomaly was associated with persistence of the left superior caval vein, which drained to the coronary sinus, and non-compaction of the left ventricular myocardium. The association of these lesions is rare in patients with Turner's syndrome.

Anatomical considerations for the management of a left-sided superior caval vein draining to the roof of the left atrium

2016 ◽  
Vol 27 (5) ◽  
pp. 846-850
Author(s):  
Jelena Saundankar ◽  
Andrew B. Ho ◽  
Anthony P. Salmon ◽  
Robert H. Anderson ◽  
Alan G. Magee
Keyword(s):  
Left Atrium ◽  
Coronary Sinus ◽  
Right Atrial ◽  
Caval Vein ◽  
Cross Sectional ◽  
Interatrial Communication ◽  
Unroofed Coronary Sinus ◽  
Superior Caval Vein ◽  
Coronary Sinus Ostium ◽  
The Right

AbstractAimsThe pathophysiological entity of a persisting left-sided superior caval vein draining into the roof of the left atrium represents an extreme form of coronary sinus de-roofing. This is an uncommon, but well-documented condition associated with systemic desaturation due to a right-to-left shunt. Depending on the size of the coronary ostium, the defect may also present with right-sided volume loading. We describe two patients, both of whom presented with desaturation, and highlight the important anatomical features underscoring management.Methods and ResultsBoth patients were managed interventionally with previous assessment of the size of the coronary sinus ostium through cross-sectional imaging. This revealed a restrictive interatrial communication at the right atrial mouth of the coronary sinus in both patients, which permitted an interventional approach, as the residual left-to-right shunt subsequent to closure of the aberrant vessel would be negligible. At intervention, test occlusion of the left superior caval vein allowed assessment of decompressing vessels before successful occlusion using an Amplatzer Vascular Plug.ConclusionsPersistence of a left superior caval vein draining to the left atrium may be associated with an interatrial communication at the mouth of the unroofed coronary sinus. The ostium of the de-roofed coronary sinus can be atretic, restrictive, normally sized, or enlarged. Careful assessment of the size of this defect is required before treatment. In view of its importance, which has received little attention in the literature to date, we suggest an additional consideration to the classification of unroofed coronary sinus.

Intracardiac or extracardiac conduit modification of the Fontan procedure in hearts with univentricular atrioventricular connection and left superior caval vein draining to coronary sinus

1997 ◽  
Vol 7 (2) ◽  
pp. 215-219
Author(s):  
Jacques A.M. van Son ◽  
Volkmar Falk ◽  
Friedrich W. Mohr
Keyword(s):  
Coronary Sinus ◽  
Venous Blood ◽  
Azygos Vein ◽  
Caval Vein ◽  
Arterial Circulation ◽  
Superior Caval Vein ◽  
Inferior Caval Vein ◽  
Extracardiac Conduit ◽  
Hepatic Venous Blood ◽  
Pulmonary Arterial

AbstractIn 3 patients with isomeric morphologically left atrial appendages, univentricular atrioventricular connection, concordant ventriculoarterial connections, bilateral superior caval veins, with the left one draining via the coronary sinus, together with absence of any communicating vein, interruption of inferior caval vein with drainage via a right-sided (n=2) or left-sided (n=l) azygos vein, the hepatic venous blood was rerouted via the large coronary sinus into the pulmonary arterial circulation. In a fourth patient with similar pathology, having interruption of the left-sided inferior caval vein with drainage to the left-sided superior caval vein via a left-sided azygos vein and a large communicating vein, the pathway from the left superior caval vein to the coronary sinus was correspondingly small. An extracardiac conduit was therefore constructed between the hepatic veins and the left pulmonary artery so as to reroute the hepatic venous blood into the pulmonary arterial circulation. At a mean follow-up of 8.5 months, all patients are clinically well and none of them have developed pulmonary arteriovenous malformations. To avoid the latter complication in Fontan physiology, especially in the setting of an interrupted inferior caval vein with drainage via the azygos vein, we believe that it is preferable to reroute the hepatic venous blood into the pulmonary circulation.

Atresia of the orifice of the coronary sinus after surgery

2002 ◽  
Vol 12 (3) ◽  
pp. 302-303
Author(s):  
Shigeru Tateno ◽  
Koichiro Niwa ◽  
Masaru Terai
Keyword(s):  
Arteriovenous Fistula ◽  
Coronary Sinus ◽  
Surgical Reconstruction ◽  
Caval Vein ◽  
Exercise Electrocardiography ◽  
Superior Caval Vein ◽  
Coronary Arteriovenous Fistula ◽  
St Segments

We describe a patient with a coronary arteriovenous fistula, atresia of the orifice of the coronary sinus, and persistence of the left superior caval vein. Depression of her ST segments was revealed by exercise electrocardiography long after the initial surgical reconstruction of the coronary sinus.

An unusual cause of cyanosis after the modified Fontan procedure—closure of venous communications between the coronary sinus and left atrium by transcatheter techniques

1994 ◽  
Vol 4 (2) ◽  
pp. 172-174 ◽  
Author(s):  
Alison M. Hayes ◽  
Patricia E. Burrows ◽  
Lee N. Benson
Keyword(s):  
Left Atrium ◽  
Coronary Sinus ◽  
Coil Embolization ◽  
Transcatheter Closure ◽  
Fontan Procedure ◽  
Tricuspid Atresia ◽  
The Other ◽  
The Right

SummaryCommunication of the coronary sinus with the left atrium is an unusual anomaly. Two cases of tricuspid atresia are described where systemic desaturation developed following a modified Fontan procedure. In both, investigation demonstrated a communication between the coronary sinus and the left atrium. Transcatheter closure of these communications was achieved with a ductal device in one case and coil embolization in the other. Following occlusion and elimination of the right-to-left shunt, both patients became fully saturated in room air.

Thrombolytics for late superior caval vein thrombus in a patient with tricuspid atresia and single-lung Glenn anastomosis

2015 ◽  
Vol 26 (1) ◽  
pp. 209-213
Author(s):  
Alexander R. Bonnel ◽  
Vijayapraveena Paruchuri ◽  
Wayne J. Franklin
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Left Lung ◽  
Bleeding Risk ◽  
Tricuspid Atresia ◽  
Caval Vein ◽  
Low Cardiac Output Syndrome ◽  
Superior Caval Vein ◽  
The Right ◽  
Blalock Taussig Shunt

AbstractBackgroundThose with cyanotic heart disease have an elevated bleeding risk but also are hypercoaguable. Treating haemodynamically significant thrombi in this unique cohort poses a monumental challenge.CaseA 29-year-old women with tricuspid atresia and left pulmonary artery atresia presented with superior caval vein syndrome. She had a right modified Blalock–Taussig shunt as a neonate. A left modified Blalock–Taussig shunt performed later failed to establish flow to her left lung. At age 5, she had a Fontan procedure to the right lung but could not tolerate the physiology and had a low cardiac output syndrome. The Fontan was taken down and she was left with a Glenn anastamosis to the right pulmonary artery. She did well for years until she had dyspnea, upper extremity oedema and “facial fullness”. On examination she was tachycardic, hypotensive, and more desaturated than baseline. She also had facial plethora.Decision-makingEchocardiogram showed a large 9×3 mm nearly occlusive thrombus in the superior caval vein at the bifurcation of the left and right innominate veins. An emergent venogram confirmed the location and size of the thrombus. Given the thrombus burden and potential for distal embolisation through the Glenn to the single functional lung, we chose to treat the patient with thrombolytics. She had uncomplicated ICU course and was sent home on warfarin. Follow-up echocardiogram showed complete resolution of clot.ConclusionThis case shows the importance of history and physical exam in caring for this complex cohort of adult patients with CHD.

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