Cardiac mucormycosis: a case report

Abstract Background Mucormycosis is an invasive fungal infection (IFI) most commonly seen in immunocompromised patients. Diabetic ketoacidosis, haematopoietic transplantation, iron overload states, and deferoxamine therapy are considered to be some of the classical risk factors. While cutaneous and rhino-sinusoidal forms may be seen in immunocompetent (IC) individuals, cardiac and mediastinal involvement is rare. In this report, we describe a young patient without predisposing factors who presented as mediastinal mucormycosis with extensive cardiac involvement. Case summary A 19-year-old male presented with complaints of dry cough and dyspnoea on exertion over the last 4 months. Echocardiography showed diffuse infiltration of both atria along with multiple pedunculated freely mobile masses. A computed tomography chest was done to further delineate the true extent of the disease and revealed diffuse infiltration of the mediastinum, bilateral atria and interatrial septum, pulmonary veins, and superior vena cava. A fine needle aspiration cytology from a mediastinal mass revealed broad aseptate fungal hyphae with right angled branching consistent with Mucor. Extensive evaluation could not find any predisposing factors. The patient was started on Amphotericin B and surgical debridement was contemplated. However, owing to the diffuse infiltration around the heart and mediastinal vasculature, debridement could not be performed and the patient eventually succumbed to the illness. Discussion Mediastinal mucormycosis though rare in IC patients, is a rapidly progressive condition with a high fatality. A high index of suspicion needs to be maintained in individuals presenting with infiltrative disorders of the mediastinum for early diagnosis and prompt treatment.

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A Rare but Reversible Cause of Hematemesis: “Downhill” Esophageal Varices

Case Reports in Critical Care ◽

10.1155/2016/2370109 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Lam-Phuong Nguyen ◽

Narin Sriratanaviriyakul ◽

Christian Sandrock

Keyword(s):

Portal Hypertension ◽

Superior Vena ◽

Portal Pressure ◽

Vena Cava ◽

Acute Upper Gastrointestinal Bleeding ◽

Extensive Evaluation ◽

Intrahepatic Portosystemic Shunt ◽

Stage Renal Disease ◽

End Stage ◽

High Index Of Suspicion

“Downhill” varices are a rare cause of acute upper gastrointestinal bleeding and are generally due to obstruction of the superior vena cava (SVC). Often these cases of “downhill” varices are missed diagnoses as portal hypertension but fail to improve with medical treatment to reduce portal pressure. We report a similar case where recurrent variceal bleeding was initially diagnosed as portal hypertension but later found to have SVC thrombosis presenting with recurrent hematemesis. A 39-year-old female with history of end-stage renal disease presented with recurrent hematemesis. Esophagogastroduodenoscopy (EGD) revealed multiple varices. Banding and sclerotherapy were performed. Extensive evaluation did not show overt portal hypertension or cirrhosis. Due to ongoing bleeding requiring resuscitation, she underwent internal jugular (IJ) and SVC venogram in preparation for transjugular intrahepatic portosystemic shunt (TIPS), which demonstrated complete IJ and SVC occlusion. She underwent balloon angioplasty with stent placement across SVC occlusion with complete resolution of her varices and resolved hematemesis. “Downhill” varices are extremely rare, though previously well described. Frequently, patients are misdiagnosed with underlying liver disease. High index of suspicion and investigation of alternative causes of varices is prudent in those without underlying liver diseases. Prompt diagnosis and appropriate intervention can significantly improve morbidity and mortality.

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Single-Patch Fold-Back Technique for Augmentation of the Superior Vena Cava in Sinus Venosus Atrial Septal Defect Associated with Partial Anomalous Pulmonary Venous Return

The Heart Surgery Forum ◽

10.1532/hsf98.2014433 ◽

2015 ◽

Vol 17 (6) ◽

pp. 282

Author(s):

Suguru Ohira ◽

Kiyoshi Doi ◽

Takeshi Nakamura ◽

Hitoshi Yaku

Keyword(s):

Atrial Septal Defect ◽

Superior Vena Cava ◽

Septal Defect ◽

Venous Return ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Sinus Venosus ◽

Right Atrial ◽

Anomalous Pulmonary Venous Return

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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Congenital Horner and Scimitar syndrome in a newborn: a previously unreported combination

BMJ Case Reports ◽

10.1136/bcr-2020-238018 ◽

2020 ◽

Vol 13 (11) ◽

pp. e238018

Author(s):

Joana Carvalho ◽

Mariana Maia ◽

Ágata Mota ◽

Teresa Martins

Keyword(s):

Multidisciplinary Approach ◽

Septal Defect ◽

Inferior Vena ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Scimitar Syndrome ◽

Left Superior Vena Cava ◽

Dilated Coronary Sinus ◽

Rule Out

Here we report a case of a term newborn presenting with left palpebral ptosis, anisocoria and heterochromia as well as cleft palate and heart murmur. Congenital Horner syndrome was suspected and a thoracoabdominal CT scan was performed to rule out neuroblastoma. This revealed an anomalous drainage of right pulmonary veins to a collector that drains to the inferior vena cava, leading to the diagnosis of Scimitar syndrome. Echocardiogram showed an ostium secundum atrial septal defect, enlarged right chambers and a dilated coronary sinus due to a persistent left superior vena cava. The combination of Horner and Scimitar syndrome has never been described before. This case should encourage clinicians to use a multidisciplinary approach in order to guarantee an adequate diagnosis and management.

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Fine‐needle aspiration of dermatofibrosarcoma protuberans metastasizing to hemithorax with superior vena cava compression: Case report and literature review

Diagnostic Cytopathology ◽

10.1002/dc.24179 ◽

2019 ◽

Author(s):

Bridget S. Banach ◽

Tatjana Antic ◽

Julia A. Bridge ◽

Nicole A. Cipriani ◽

Laura Frye ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Superior Vena Cava ◽

Fine Needle Aspiration ◽

Superior Vena ◽

Vena Cava ◽

Dermatofibrosarcoma Protuberans ◽

Needle Aspiration ◽

Fine Needle

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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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ANOMALIES OF THE PULMONARY VEINS AND THEIR SURGICAL SIGNIFICANCE

PEDIATRICS ◽

10.1542/peds.9.2.152 ◽

1952 ◽

Vol 9 (2) ◽

pp. 152-166

Author(s):

HARRY G. PARSONS ◽

ANN PURDY ◽

BRUCE JESSUP

Keyword(s):

Superior Vena Cava ◽

Clinical Symptoms ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Ductus Venosus ◽

Return Flow ◽

Right Heart ◽

Surgical Measures ◽

The Right

The successful operations upon abnormalities of the outflow tracts of the heart suggest that surgical measures may also be applied to the correction of abnormal inflow tracts. Technically the anastomosis of veins to the auricle has been proved feasible in the experimental animal. Therefore, it should be possible to correct abnormally placed pulmonary veins in man. A wide variety of such anomalies occur. In 55 of 136 reported cases, all the oxygenated blood from the lungs was returned to the right heart through anomalous vessels. Thirty-five per cent of these cases of complete diversion were accompanied by other major cardiac defects. It is estimated that 50% or more of the return flow from the lungs must reach the right heart to produce clinical symptoms. Two cases are presented of persistence of the left superior vena cava which transmitted all the freshly oxygenated blood to the right auricle, by way of the left innominate and the right superior vena cava. The clinical picture was that of growth retardation, minimal cyanosis, a huge hyperactive heart, a loud left mesocardial systolic murmur, pulsating shadows in both upper pulmonary fields, and nearly identical oxygen-saturation of blood obtained from the right heart and femoral artery. One case is reported in which all the oxygenated blood from the lungs is carried to the right auricle by way of the ductus venosus. Surgical correction of the abnormality of these cases by transplantation of one or more of the veins would have been possible. However, no case known to the authors has yet been successfully corrected.

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TYPES OF CORRECTION OF THE SUPRACARDIAC FORM OF PARTIAL ABNORMAL DRAINAGE OF THE PULMONARY VEINS. WARDEN PROCEDURE

BULLETIN OF SURGERY IN KAZAKHSTAN ◽

10.35805/bsk2021iii028 ◽

2021 ◽

pp. 28-31

Author(s):

Inkar Sagatov ◽

Nurzhan Dosmailov

Keyword(s):

Left Atrium ◽

Superior Vena Cava ◽

Right Atrium ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Artificial Circulation ◽

The Right

The article describes the types of correction of the supracardial form of abnormal drainage of the pulmonary veins. One of the methods of correcting this defect is the Warden operation, which includes: after sternotomy, connection of artificial circulation, cardioplegia, the superior vena cava is cut off, the proximal end is sutured. Next, a right atriotomy is performed, an anastomosis is formed using an autopericardial patch between the abnormal drainage and the left atrium through the ASD. Then an anastomosis is formed between the auricle of the right atrium and the distal end of the superior vena cava. As a result, blood from the abnormal pulmonary veins begins to drain into the left atrium through the ASD.

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Selective parasympathectomy of automatic and conductile tissues of the canine heart

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1985.248.1.h61 ◽

1985 ◽

Vol 248 (1) ◽

pp. H61-H68 ◽

Cited By ~ 6

Author(s):

W. C. Randall ◽

J. L. Ardell

Keyword(s):

Vagal Stimulation ◽

Superior Vena ◽

Sympathetic Innervation ◽

Pulmonary Veins ◽

Vena Cava ◽

Dorsal Surface ◽

Atrial Pacing ◽

Canine Heart ◽

Surgical Interventions ◽

The Right

From right thoracotomy (T4-T5), the canine heart was suspended in its pericardium to expose its major venous inputs. Vagal and sympathetic trunks were prepared for electrical stimulation (10-20 Hz, 5.0 ms, 3-5 V) before and after each separate denervation procedure. Vagal stimulation was instituted with and without concurrent atrial pacing. The following surgical interventions were performed. 1) The superior vena cava was cleared of connective and nervous tissues from the pericardial reflection caudally to the level of the right pulmonary artery. 2) The azygos vein was cleared, tied, and sectioned. 3) The right pulmonary veins were isolated and cleared intrapericardially. 4) The dorsal surface of the atria was dissected between the right and left pulmonary veins and painted with phenol. Each step in the procedure elicited successive stepwise deletion of parasympathetic influences on sinoatrial tissues of the canine heart with only minor ablation of sympathetic inputs. 5) Dissection of the triangular fat pad at the junction of the inferior vena cava and inferior left atrium eliminated the remaining parasympathetic efferent input to the heart with dramatic deletion of atrioventricular block during either left or right vagal stimulation, again with preservation of most of the sympathetic innervation. These experiments clearly demonstrate differential and selective inputs of parasympathetic pathways to sinoatrial (SAN) and atrioventricular (AVN) regions of the dog heart but relatively little interference with sympathetic distributions.(ABSTRACT TRUNCATED AT 250 WORDS)

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Cor Triatriatum in Association With a Unique Form of Partial Anomalous Pulmonary Venous Connection

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211046907 ◽

2021 ◽

pp. 215013512110469

Author(s):

Lou Capecci ◽

Richard D. Mainwaring ◽

Inger Olson ◽

Frank L. Hanley

Keyword(s):

Superior Vena Cava ◽

Superior Vena ◽

Pulmonary Veins ◽

Vena Cava ◽

Venous Drainage ◽

Cor Triatriatum ◽

Unique Form ◽

Elective Repair ◽

The Right ◽

Anomalous Pulmonary Venous Connection

Cor triatriatum may be associated with abnormalities of pulmonary venous anatomy. This case report describes a unique form of partial anomalous pulmonary venous connection. The patient presented at 5 weeks of age with symptoms of tachypnea and poor feeding. Echocardiography demonstrated cor triatriatum and partial anomalous pulmonary venous drainage of the right upper lung. The patient underwent urgent repair of cor triatriatum. It was elected to not address the partial anomalous pulmonary venous connection at that time. The patient returned at age 19 months for elective repair of the anomalous pulmonary venous connection. There was also a large vein connecting the right lower pulmonary veins to the superior vena cava. This was repaired by dividing the superior vena cava along a vertical axis to redirect the flow of the anomalous pulmonary veins through the connecting vein to the left atrium. This report describes the anatomy and surgical approach to a unique form of anomalous pulmonary venous connection.

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