scholarly journals Hematemesis, a Rare Presentation for Downhill Esophageal Varices

2021 ◽  
pp. 359-364
Author(s):  
Jeremy Van ◽  
Shubha Singh
Keyword(s):  
Blood Flow ◽  
Esophageal Varices ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Disease Process ◽  
Rare Presentation ◽  
Retrograde Blood Flow ◽  
Flow Through ◽  
The Right

Downhill esophageal varices (DEV) are a rare form of esophageal varices associated with superior vena cava obstruction. Obstruction leads to retrograde blood flow through collateral venous channels, including the esophageal venous plexus, to redirect blood flow to the right atrium via the inferior vena cava. This leads to the formation of DEV. It is a rare phenomenon to have gastrointestinal bleeding, especially hematemesis, on a patient’s first presentation with this disease process. We describe such a case here involving a patient with DEV secondary to metastatic renal cell carcinoma presenting with hematemesis.

Management of Superior Vena Cava Occlusion Causing Bleeding “Downhill” Esophageal Varices

2021 ◽  
pp. 152660282198933
Author(s):  
Pablo V. Uceda ◽  
Julio Peralta Rodriguez ◽  
Hernán Vela ◽  
Adelina Lozano Miranda ◽  
Luis Vega Salvatierra ◽  
...  
Keyword(s):  
Superior Vena Cava ◽  
Esophageal Varices ◽  
Superior Vena ◽  
Vena Cava ◽  
Central Venous Catheters ◽  
Dialysis Patients ◽  
Central Venous ◽  
Endovascular Recanalization ◽  
Flow Through ◽  
The Right

The health care system in Peru treats 15,000 dialysis patients annually. Approximately 45% of patients receive therapy using catheters. The incidence of catheter-induced superior vena cava (SVC) occlusion is increasing along with its associated significant morbidity and vascular access dysfunction. One of the unusual manifestations of this complication is bleeding “downhill” esophageal varices caused by reversal of blood flow through esophageal veins around the obstruction to the right atrium. Herein is presented the case of an 18-year-old woman on hemodialysis complicated by SVC occlusion and bleeding esophageal varices who underwent successful endovascular recanalization of the SVC. Bleeding from “downhill” esophageal varices should be considered in the differential diagnosis of dialysis patients exposed to central venous catheters. Aggressive endovascular treatment of SVC occlusion is recommended to preserve upper extremity access function and prevent bleeding from this complication.

Blood flow through vasa vasorum in arteries and veins: effects of luminal PO2

1986 ◽  
Vol 250 (3) ◽  
pp. H434-H442 ◽  
Author(s):  
D. D. Heistad ◽  
M. L. Armstrong ◽  
S. Amundsen
Keyword(s):  
Blood Flow ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena ◽  
Acute Hypoxia ◽  
Vena Cava ◽  
Vasa Vasorum ◽  
Aortic Media ◽  
Flow Through ◽  
Arteries And Veins

We have examined effects of chronic reduction of intraluminal PO2 on blood flow through vasa vasorum, by comparing large arteries and veins, and effects of acute hypoxia on flow through vasa. Microspheres were used to measure flow in anesthetized dogs. Values obtained with different sizes of microspheres suggest that spheres 9 and 15 micron in diam, but not 50 micron, are appropriate for measurement of blood flow through vasa vasorum. Flow [expressed as ml X min-1 X 100 g-1 (SE)] through medial vasa was similar in the aorta (9.0 +/- 2.1) and pulmonary artery (9.3 +/- 1.1) although, on the basis of wall thickness and number of lamellae, one would predict much higher levels of flow to aortic media. Two veins that we studied have a thick muscular wall. Both veins had high levels of flow through medial vasa: 33 +/- 4.4 to the subdiaphragmatic inferior vena cava and 18 +/- 5.4 to the portal vein. Two other veins are apparently conduit vessels, with dense connective tissue and minimal smooth muscle. Both veins had minimal flow through medial vasa: 2.4 +/- 1.0 to superior vena cava, and 1.9 +/- 0.8 to supradiaphragmatic inferior vena cava. Thus, because flow through vasa differs greatly in different veins, structure of the vessel (as well as intraluminal PO2) is an important determinant of flow through vasa. Acute hypoxia increased conductance of medial vasa vasorum of arteries and veins when neurohumoral constrictor effects were blocked by phenoxybenzamine.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Emphysematous pyelonephritis with air bubble in the inferior vena cava

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Tiffany A. Perkins ◽  
Alberic Rogman ◽  
Murali K. Ankem
Keyword(s):  
Septic Shock ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Rare Presentation ◽  
Emphysematous Pyelonephritis ◽  
Case Presentation ◽  
Air Bubble ◽  
First Case ◽  
The Right

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.

scholarly journals Vena Caval Anomalies

2013 ◽  
Vol 3 ◽  
pp. 51 ◽  
Author(s):  
Ramyah Rajakulasingam ◽  
Rohin Francis ◽  
Ramanan Rajakulasingam
Keyword(s):  
Aortic Valve ◽  
Inferior Vena Cava ◽  
Superior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Cardiac Procedures ◽  
The Right

Anomalous vena cavae can have significant implications for procedures on the right side of the heart. We report a rare anatomical configuration in a 44-year-old female, which to the best of our knowledge, is the first report of such an association. She had a bicuspid aortic valve in conjunction with a persistent left superior vena cava (PLSVC) draining into the coronary sinus, and a left-sided inferior vena cava (IVC) draining into a left superior vena cava via the hemiazygos vein. Comprehensive assessment of these anomalies is crucial given the widespread use of invasive cardiac procedures.

Modified total cavopulmonary shunt as a staged Fontan operation

2017 ◽  
Vol 26 (9) ◽  
pp. 701-703
Author(s):  
Hidetsugu Asai ◽  
Tsuyoshi Tachibana ◽  
Yasushige Shingu ◽  
Hiroki Kato ◽  
Satoru Wakasa ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Right Ventricular ◽  
Superior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena ◽  
Fontan Operation ◽  
Vena Cava ◽  
Left Superior Vena Cava ◽  
The Right ◽  
Cavopulmonary Shunt

The left superior vena cava became occluded in an infant with hypoplastic left heart syndrome. After a bidirectional Glenn procedure, he presented with severe oxygen desaturation and right ventricular dysfunction; the left superior vena cava drained into the inferior vena cava through collateral veins. As salvage therapy, we created a modified total cavopulmonary shunt using only autologous tissue in which the right hepatic vein and inferior vena cava drained into the pulmonary artery via a lateral tunnel in the right atrium. Immediately after surgery, his oxygen saturation increased and right ventricular function improved.

Hemodynamics Characteristics of a Four-Way Right-Atrium Bypass Connector

2017 ◽  
Author(s):  
Elizabeth Mack ◽  
Alexandrina Untaroiu
Keyword(s):  
Blood Flow ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Pulmonary Arteries ◽  
Vena Cava ◽  
Design Parameters ◽  
Patient Specific ◽  
Optimal Size ◽  
The Right

Currently, the surgical procedure followed by the majority of cardiac surgeons to address right ventricular dysfunction is the Fontan procedure, which connects the superior and inferior vena cava directly to the left and right pulmonary arteries bypassing the right atrium. However, this is not the most efficient configuration from a hemodynamics perspective. The goal of this study is to develop a patient-specific 4-way connector to bypass the dysfunctional right ventricle and augment the pulmonary circulation. The 4-way connector is intended to channel the blood flow from the inferior and superior vena cava directly to the right and left pulmonary arteries. By creating a connector with proper hemodynamic characteristics, one can control the jet flow interactions between the inferior and superior vena cava and streamline the flow towards the right and left pulmonary arteries. In this study the focus is on creating a system that can identify the optimal configuration for the 4-way connector for patients from 0–20 years of age. A platform is created in ANSYS that utilizes the DOE function to minimize power-loss and blood damage propensity in the connector based on junction geometries. A CFD model is created to simulate the blood flow through the connector. Then the geometry of the bypass connector is parameterized for DOE process. The selected design parameters include inlet and outlet diameters, radius at the intersection, and length of the connector pathways. The chosen range for each geometric parameter is based on the relative size of the patient’s arteries found in the literature. It was confirmed that as the patient’s age and artery size change, the optimal size and shape of the connector also changes. However, the corner radius did not decrease at the same rate as the opening diameters. This means that creating different sized connectors is not just a matter of scaling the original connector to match the desired opening diameter. However, it was found that power losses within the connector decrease and average and maximum blood traversal time through the connector increased for increasing opening radius. This information could be used to create a more specific relationship between the opening radius and the flow characteristics. So in order to create patient specific connectors, either a new more complicated trend needs to be found or an optimization program would need to be run on each patient’s specific geometry when they need a new connector.

scholarly journals Right atrium and superior vena cava pressure measurements in a novel animal model to study one and a half ventricle repair as compared to Fontan type procedure

2017 ◽  
Vol 12 (4) ◽  
pp. 143-149 ◽  
Author(s):  
Anil Bhattarai ◽  
Arben Dedja ◽  
Vladimiro L. Vida ◽  
Francesco Cavallin ◽  
Massimo A. Padalino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Inferior Vena Cava ◽  
Superior Vena Cava ◽  
Inferior Vena ◽  
Superior Vena ◽  
Stress Test ◽  
Vena Cava ◽  
Right Pulmonary Artery ◽  
The Right ◽  
Group 1

Background & Objectives: To evaluate the advantages of the one and a half ventricle repair on maintaining a low pressure in the inferior vena cava district. Also evaluate the competition of flows at the superior vena cava – right pulmonary artery anastomosis site, in order to understand the hemodynamic interaction of a pulsatile flow in combination to a laminar one. Materials & Methods: Adult rabbits (n=30) in terminal anaesthesia with a follow up of 8 h were used, randomly distributed in three experimental groups: Group 1: animals with an anastomosis between superior vena cava and right pulmonary artery, as a model of one and one half ventricle repair; Group 2: animals with the cavopulmonary anastomosis followed by clamping of the right pulmonary artery proximal to the anastomosis; and Group 3: sham animals. Pressures of superior vena cava and pulmonary arteries were afterwards measured, in a resting condition as well as after induced pharmacological stress test.Results: In Group 1, superior vena cava pressure was significantly higher, while venous pressure in the inferior vena cava – right atrium district was constant or lower in comparison with the other groups. After stress test, the pressure in the superior vena cava and the heart rate both increased further, but the right ventricular, right atrial and pulmonary artery pressures remained similar to the values in a resting condition. This proved that the inferior vena cava return was well-preserved, and no venous hypertension was present in the inferior vena cava district even after stress test (good exercise tolerance).Conclusion: One and one half ventricle repair can be considered a good surgical strategy for maintaining a low pressure in the inferior vena cava district with potential for right ventricle growth, restoring the more physiological circulation in borderline or failing right ventricle conditions. The experiment presented a positive finding in favour of one and one half ventricle repair, as compared to Fontan type procedure.

Right Atrial Surgery without Caval Snaring

2005 ◽  
Vol 1 (2) ◽  
pp. 75-78 ◽  
Author(s):  
Reddy Dandolu ◽  
Douglas Eaton ◽  
Aras Ali ◽  
Nannette Schwann ◽  
Andrew Wechsler
Keyword(s):  
Animal Model ◽  
Right Atrium ◽  
Inferior Vena ◽  
Superior Vena ◽  
Vena Cava ◽  
Drainage System ◽  
Mitral Valve Surgery ◽  
Right Atrial ◽  
Percutaneous Cannulation ◽  
The Right

Background During tricuspid valve replacement in a patient with previous mitral valve surgery, we made an incidental observation that the right atrium can be opened without caval snaring and without air entering the venous reservoir. We tested this hypothesis on an animal model. Methods Two patients underwent right atrial surgery using percutaneous cannulation, and no air was entrained without caval snaring. This principle was tested in an animal model using 2 pigs weighing 80 kg each. Percutaneous cannulae were placed under epicardial echo guidance with their tips 4 cm from the right atrium. A “collapsible bag with air drainage system” was introduced into the venous return system to quantify air return from the superior vena cava (SVC) and inferior vena cava (IVC). Two types of percutaneous cannulae with (Cardiovations Quick Draw) and without (Biomedicus) proximal side holes were tested. Results In the animal model using Biomedicus cannulae, upon opening the right atrium, air was entrained from the SVC cannula at 60 mL/minute with no air in the IVC. There was no difference in the amount of air between the two cannulae. Pressures measured were 5 cm of water in the IVC and −20 cm water in the SVC. Epicardial ultrasound demonstrated complete collapse of both vena cavae. Partial clamping of the SVC cannula reduced the amount of air to 60 cc/min, and placing a small straight clamp at the SVC atrial junction eliminated the air. No air was noted in IVC cannula. Conclusions Inferior vena caval drainage by percutaneous cannula does not entrain air with either type of cannula and without snaring (both in clinical cases and animal model). This might be explained by the presence of a competent Eustachian valve. However, the SVC is not immune to air. Minimal air (approximately 60 mL/minute) could be managed by partial clamping or completely be avoided by placing a small straight clamp without snaring.

Sign in / Sign up

Export Citation Format

Share Document