scholarly journals P172 Uncommon reason for right-sided heart failure

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
Z Mladenovic ◽  
S O Obradovic ◽  
I R Ilic ◽  
D J L J Djenic ◽  
V D Vranes ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Lateral Wall ◽  
Middle Part ◽  
Right Atrial ◽  
Bleeding Complications

Abstract This paper outlines a case study 57 year old, female patient who was admitted in our institution due to severe sign and symptoms of right-sided heart failure. She complained on progressive fatigue, a shortness of breath and oedema of cruris for three months before. Initially she was hospitalized in regional hospital due to pericardial effusion and they excluded any malignancy and systemic tissue disease in that moment. Immediately after admission we have performed 2D transthoracic echocardiography which showed a large (6.7x4.9cm), oval tumours soft tissue formation in right atrium which compromise flow in Vena cava inferior and across tricuspid valve and make a gradient of 35 mmHg above it. Left and right ventricles had preserved dimensions and function, without pericardial effusion. 3D transoesophageal echocardiography (TEE) imaged confirmed huge, oval tumorous formation (8.2x7.9cm), which originated from lateral wall of right atrium and almost occupied it, compromising flow towards superior and inferior vena cava. We had detected an irregular free space, probably due to necrosis, in the middle part of that tumorous formation. Thorax MSCT revealed heterogeneous expansive mass (19x8x8 cm) in projection of right atrium with signs of active bleeding its central part, although MSCT couldn’t exclude extra cardiac origin. There were no signs of dissemination. Cardiac MR indicated that we had extra cardiac mass (12x9x10cm) close to lateral right atrial wall and basal part of lateral wall of right ventricle which compromise flow towards superior and inferior vena cava, with no changes on surrounding structures. The patient underwent almost complete tumour surgical resection, with a lot of bleeding complications due to its local invasiveness and central necrosis. Surgical findings completely were concordant with 3D TEE imagining which provided us very precise information about size, location and extension of tumour. Severe systemic inflammatory response syndrome (SIRS) occurred in the postoperative period, and the patient died due to multiple organ dysfunction. Patohistological analyses were conclusive of undifferentiated pleomorphic sarcoma diagnosis. Abstract P172 Figure.

scholarly journals Advanced Hepatocellular Carcinoma with Subtotal Occlusion of the Inferior Vena Cava and a Right Atrial Mass

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Christian Steinberg ◽  
Suzanne Boudreau ◽  
Felix Leveille ◽  
Marc Lamothe ◽  
Patrick Chagnon ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Great Majority ◽  
Right Atrial ◽  
Advanced Hepatocellular Carcinoma ◽  
Regional Lymph Nodes ◽  
The Right

Hepatocellular carcinoma usually metastasizes to regional lymph nodes, lung, and bones but can rarely invade the inferior vena cava with intravascular extension to the right atrium. We present the case of a 75-year-old man who was admitted for generalized oedema and was found to have advanced HCC with invasion of the inferior vena cava and endovascular extension to the right atrium. In contrast to the great majority of hepatocellular carcinoma, which usually develops on the basis of liver cirrhosis due to identifiable risk factors, none of those factors were present in our patient.

scholarly journals Huge Intravascular Tumor Extending to the Heart: Leiomyomatosis

2015 ◽  
Vol 2015 ◽  
pp. 1-3 ◽  
Author(s):  
Suat Doganci ◽  
Erkan Kaya ◽  
Murat Kadan ◽  
Kubilay Karabacak ◽  
Gökhan Erol ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Median Sternotomy ◽  
Vena Cava ◽  
Iliac Vein ◽  
Venous Occlusion ◽  
Right Atrial ◽  
High Recurrence Rate ◽  
Warfarin Sodium

Intravenous leiomyomatosis (IVL) is a rare neoplasm characterized by histologically benign-looking smooth muscle cell tumor mass, which is growing within the intrauterine and extrauterine venous system. In this report we aimed to present an unusual case of IVL, which is originating from iliac vein and extended throughout to right cardiac chambers. A 49-year-old female patient, who was treated with warfarin sodium due to right iliac vein thrombosis, was admitted to our department with intermittent dyspnea, palpitation, and dizziness. Physical examination was almost normal except bilateral pretibial edema. On magnetic resonance venography, there was an intravenous mass, which is originated from right internal iliac vein and extended into the inferior vena cava. Transthoracic echocardiography and transesophageal echocardiography revealed a huge mass extending from the inferior vena cava through the right atrium, with obvious venous occlusion. Thoracic, abdominal, and pelvic MR showed an intravascular mass, which is concordant with leiomyomatosis. Surgery was performed through median sternotomy. A huge mass with 25-cm length and 186-gr weight was excised through right atrial oblique incision, on beating heart with cardiopulmonary bypass. Histopathologic assessment was compatible with IVL. Exact strategy for the surgical treatment of IVL is still controversial. We used one-stage approach, with complete resection of a huge IVL extending from right atrium to right iliac vein. In such cases, high recurrence rate is a significant problem; therefore it should be kept in mind.

Abstract 13532: Comparison of Inferior Vena Cava and Subclavian Vein Collapsibility Index by Ultrasound for Determination of Relative Intravascular Volume in Acute Decompensated Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yvonne E Kaptein ◽  
Pedro D Salinas ◽  
Payal Sharma ◽  
Ana Christina Perez Moreno ◽  
Nasir Sulemanjee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Inferior Vena Cava ◽  
Subclavian Vein ◽  
Inferior Vena ◽  
Acute Decompensated Heart Failure ◽  
Vena Cava ◽  
Decompensated Heart Failure ◽  
Right Atrial ◽  
Intravascular Volume ◽  
Collapsibility Index

Introduction: Accurate assessment of relative intravascular volume is needed to guide management of acute decompensated heart failure (ADHF). Current assessments include history and physical examination (specific but not sensitive), and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) (sensitive but not specific).Ultrasound (US) of inferior vena cava (IVC) collapsibility with respiration is commonly used to assess intravascular volume and right atrial pressure (RAP) but may be technically challenging. US of subclavian vein (SCV) collapsibility may provide an alternative assessment. Hypothesis: In ADHF, SCV collapsibility index (CI) may correlate with IVC CI and RAP. Methods: Prospective study of non-ventilated patients with ADHF who had NT-proBNP within 24 hours of paired IVC and SCV diameter measurements by US. Results: Forty-two patients (median age 66.5 years, 45% female, and 64% white) were enrolled, with 52 encounters. Cardiovascular comorbidities included hypertension (93%), chronic kidney disease (64%), coronary artery disease (55%), atrial fibrillation/flutter (55%), and valvular disease (55%). Of 38 patients with known heart failure, 63% had HFrEF, 16% HFmrEF, and 21% HFpEF.Correlation of paired IVC CI and SCV CI with relaxed breathing was R = 0.65 (N = 36). Correlation of paired IVC CI and SCV CI with forced inhalation was R = 0.47 (N = 36). Log 10 NT-proBNP was inversely correlated with IVC CI (R = -0.35; N = 51) and SCV CI (R = -0.33; N = 36). For patients with right heart catheterization within 24 hours of US, correlation of RAP to IVC CI was R = -0.53 (N = 9), and RAP to SCV CI was R = -0.65 (N = 9). Moderate or severe tricuspid regurgitation decreased CI independently of intravascular volume and RAP (figure). Conclusions: US measurements of SCV CI correlate well with paired IVC CI in non-ventilated ADHF. RAP by RHC correlated better with SCV CI than with IVC CI. SCV CI may be a reliable alternative to IVC CI in assessing relative intravascular volume.

Pericardial effusion: Diagnostic value of the subcostal acoustic window (inferior vena cava-right atrial projection)

1987 ◽  
Vol 10 (4) ◽  
pp. 261-266 ◽  
Author(s):  
J. Candell-Riera ◽  
H. Garc-a-del-castillo ◽  
G. Permanyer-Miralda ◽  
J. Soler-Soler
Keyword(s):  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Diagnostic Value ◽  
Right Atrial ◽  
Acoustic Window

scholarly journals Right Atrial Fibroelastoma Presenting as Typical Atrial Flutter: Rare Disease in Unusual Location

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Ahmad Abuarqoub ◽  
Ghada Elshimy ◽  
Muhammed Shittu ◽  
Aiman Hamdan ◽  
Fayez Shamoon
Keyword(s):  
Inferior Vena Cava ◽  
Atrial Flutter ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Right Atrial ◽  
Unusual Location ◽  
Typical Atrial Flutter ◽  
The Right ◽  
Right Atria

Typical atrial flutter as initial presentation of papillary fibroelastoma involving the cavotricuspid isthmus is not described before in literature. To our knowledge only 14 cases have been reported in literature involving the right atrium. Very unusual location is at the junction between inferior vena cava (IVC) and right atria as only 1 case has been reported.

Coronary sinus diameter to inferior vena cava diameter ratio in the diagnosis of cardiac tamponade: a novel approach

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E.H Ozcan Cetin ◽  
M.S Cetin ◽  
B Tekin Tak ◽  
F.A Ekizler ◽  
F Ozcan ◽  
...  
Keyword(s):  
Pericardial Effusion ◽  
Inferior Vena Cava ◽  
Cardiac Tamponade ◽  
Coronary Sinus ◽  
Inferior Vena ◽  
Vena Cava ◽  
Area Under The Curve ◽  
Right Atrial ◽  
P Value ◽  
Large Pericardial Effusion

Abstract Background and aim Coronary sinus (CS) as an intrapericardial, low-pressure, thin-walled structure can be easily compressed in cardiac tamponade. Whereas, inferior vena cava (IVC) is an extrapericardial structure which dilates in tamponade as opposed to the response of CS. The inverse relationship between these two venous structures may augment their role in the evaluation of tamponade imaging. Therefore, we assessed the usefullness of computerized tomographic measures of CS diameter, and also CS to IVC ratio (CS/IVC) to predict tamponade in clinically stable patients with large pericardial effusion. Materials and methods 66 clinically stable patients who had large pericardial effusions, were included to the study. CS diameter was measured from the point at 1 cm proximal to the CS ostium11. IVC diameter was measured from the segment between its right atrial orifice and hepatic vein. Results Patients with tamponade had 40% smaller CS diameter (5.3±1.8 vs 8.8±2.6 mm p<0.001) and 35% lower CS/IVC ratio (20.7±5.5 vs 34.7±10.5% p<0.001).After adjusting with other parameters, only either CS diameter or CS/IVC ratio predicted tamponade respectively. (Nagelkerke r square value for CS diameter was 53.7% and 72.1% for CS/IVC ratio). 1 mm increase in CS diameter and 1% increase in CS/IVC ratio were associated with an increased odds ratio of 59% and 39% in predicting tamponade, respectively (p value <0.001).In ROC analysis, a cut of value of 6.85 mm for CS diameter, had 82.6% sensitivity and 83.7% specificity for predicting cardiac tamponade (Area under the curve 0.879, p<0.001). Additionally, a cut of value of 27% for CS / IVC ratio had 87.0% sensitivity and 86.0% specificity for predicting cardiac tamponade (Area under the curve 0.945, p<0.001). Conclusion The tomographic measures of both the CS diameter and the CS/IVC ratio predicted tamponade in clinically stable patients with large pericardial effusion. Compared with CS diameter, CS/IVC ratio seemed to be a more powerful predictor of tamponade Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Inferior vena cava leiomyosarcoma with right atrium tumorous mass presenting as heart failure in a 70-year-old man: A case report

Cor et Vasa ◽  
2016 ◽  
Vol 58 (5) ◽  
pp. e458-e465 ◽  
Author(s):  
Pavel Kukla ◽  
Leoš Pleva ◽  
Martin Porzer ◽  
Radim Brát ◽  
Petr Handlos ◽  
...  
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava

scholarly journals P1460 Atrial myxoma with atypical location in an asymptomatic patient

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Shirka ◽  
A Doko ◽  
V Paparisto ◽  
R Osmenaj ◽  
H Gjergo ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Left Ventricular ◽  
Atrial Myxoma ◽  
Right Atrial ◽  
Left Ventricular Ejection ◽  
Transthoracic Echocardiogram ◽  
The Right

Abstract Introduction Primary cardiac tumours are rare. Most of them are benign, among which myxomas are the most common. Usually they occur in the left atrium (75%) but there are cases of right atrial myxomas. The majority of patients with atrial myxoma present with one or more symptoms of clinical triad of embolic events, intracardiac obstruction, or nonspecific manifestations. We report a rare case of cardiac myxoma arising from the right atrium as an accidental finding during routine medical checkup. Case report A 52 years-old woman was admitted to ambulatory care for a general checkup. At presentation, her heart rate was 82 bpm, regular and blood pressure was 150/90 mmHg. Other investigative results were normal. Her ECG showed normal sinus rhythm. She was sent for a routine echocardiography to judge for further treatment of the arterial hypertension. Transthoracic echocardiogram showed normal left ventricular ejection fraction. There was a mobile echogenic mass of nearly 6 cm2 in the right atrium, prolapsing through the tricuspid valve with mild tricuspid regurgitation without causing obstruction and protruding into the inferior vena cava (IVC). The transesophageal echocardiographic examination confirmed the presence of a mobile multilobular mass in the right atrial free wall close to the IVC origin. A total body angio-CT scan showed an intraatrial mass measuring approximately 5 × 4 cm, without infiltration of the adjacent structures, suggesting the diagnosis of myxoma. Coronary angiography revealed normal coronary arteries. The patient underwent median sternotomy under general anesthesia. The tumor was completely excised through a right atriotomy. The resected mass was sent for histological assessment which confirmed the diagnosis of myxoma. Discussion RA myxomas usually originate in the fossa ovalis or base of the interatrial septum, but in this case, the myxoma was implanted in the atrial inferior vena cava junction. Myxomas are usually polypoid and pedunculated tumors (approximately 83% of cases). In this report, our patient had a solitary, pedunculated mass with polypoid areas and a lobulated surface. Echocardiography remains the best diagnostic method for locating and assessing the extent of myxomas and for detecting their recurrence, with a sensitivity of up to 100%. However, transthoracic echocardiogram may not identify tumors smaller than 5 mm in diameter, and a transesophageal echocardiogram is required when there is suspicion of a very small tumor. In this case, an echocardiogram suggested the hypothesis of RA myxoma, which was confirmed by a histopathological exam. Myxomas are friable with high chance of systemic or pulmonary embolization depending on tumour location. Early diagnosis and timely surgical resection is the treatment of choice to prevent possible fatal consequences such as sudden death. Abstract P1460 Figure. Right Atrial Myxoma

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