Intermittent Occlusion of the Superior Vena Cava to Improve Hemodynamics in Patients With Acutely Decompensated Heart Failure: The VENUS-HF Early Feasibility Study

Background: Reducing congestion remains a primary target of therapy for acutely decompensated heart failure. The VENUS-HF EFS (VENUS-Heart Failure Early Feasibility Study) is the first clinical trial testing intermittent occlusion of the superior vena cava with the preCARDIA system, a catheter mounted balloon and pump console, to improve decongestion in acutely decompensated heart failure. Methods: In a multicenter, prospective, single-arm exploratory safety and feasibility trial, 30 patients with acutely decompensated heart failure were assigned to preCARDIA therapy for 12 or 24 hours. The primary safety outcome was a composite of major adverse cardiovascular and cerebrovascular events through 30 days. Secondary end points included technical success defined as successful preCARDIA placement, treatment, and removal and reduction in right atrial and pulmonary capillary wedge pressure. Other efficacy measures included urine output and patient-reported symptoms. Results: Thirty patients were enrolled and assigned to receive the preCARDIA system. Freedom from device- or procedure-related major adverse events was observed in 100% (n=30/30) of patients. The system was successfully placed, activated and removed after 12 (n=6) or 24 hours (n=23) in 97% (n=29/30) of patients. Compared with baseline values, right atrial pressure decreased by 34% (17±4 versus 11±5 mm Hg, P <0.001) and pulmonary capillary wedge pressure decreased by 27% (31±8 versus 22±9 mm Hg, P <0.001). Compared with pretreatment values, urine output and net fluid balance increased by 130% and 156%, respectively, with up to 24 hours of treatment ( P <0.01). Conclusions: We report the first-in-human experience of intermittent superior vena cava occlusion using the preCARDIA system to reduce congestion in acutely decompensated heart failure. PreCARDIA treatment for up to 24 hours was well tolerated without device- or procedure-related serious or major adverse events and associated with reduced filling pressures and increased urine output. These results support future studies characterizing the clinical utility of the preCARDIA system. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03836079.

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Tricuspid valve obstruction and right heart failure due to a giant right atrial myxoma arising from the superior vena cava

Journal of Cardiothoracic Surgery ◽

10.1186/1749-8090-8-200 ◽

2013 ◽

Vol 8 (1) ◽

Cited By ~ 4

Author(s):

Zheng-hua Xiao ◽

Jia Hu ◽

Da Zhu ◽

Ying-kang Shi ◽

Er-yong Zhang

Keyword(s):

Heart Failure ◽

Superior Vena Cava ◽

Tricuspid Valve ◽

Superior Vena ◽

Vena Cava ◽

Right Heart Failure ◽

Atrial Myxoma ◽

Right Atrial ◽

Right Heart ◽

Right Atrial Myxoma

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

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2020.12.007 ◽

2021 ◽

Vol 64 ◽

pp. 91-94

Author(s):

Valentino Ducceschi ◽

Francesco Maddaluno

Keyword(s):

Atrial Flutter ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Right Atrial

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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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Successful implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava

Vojnosanitetski pregled ◽

10.2298/vsp1312162v ◽

2013 ◽

Vol 70 (12) ◽

pp. 1162-1164

Author(s):

Mihailo Vukmirovic ◽

Lazar Angelkov ◽

Filip Vukmirovic ◽

Irena Tomasevic-Vukmirovic

Keyword(s):

Heart Failure ◽

Superior Vena Cava ◽

Superior Vena ◽

Biventricular Pacing ◽

Severe Heart Failure ◽

Vena Cava ◽

Left Superior Vena Cava ◽

Persistent Left Superior Vena ◽

Lead Placement ◽

The Right

Introduction. Persistent left superior vena cava is the most common thoracic venous abnormality which is usually asymptomatic, found incidentally during pacemaker implantation. The main problem is related to reaching the appropriate pacing site and ensuring stable lead placement. Case report. We reported a successful implantation of a biventricular pacing and defibrillator device (CRT-D) via a persistent left superior vena cava in a 55-year-old man with dilated cardiomyopathy and severe heart failure. A persistent left superior vena cava was detected during CRT-D implantation. We managed to position electrodes in the right ventricular outflow tract, a posterior branch of the coronary sinus and in the right atrium. Conclusion. Congenital anomalies of thoracic veins may complicate lead placement on the appropriate and stable position. The presented case demonstrates a successful biventricular pacing and defibrillator therapy device implantation in a patient with dilated cardiomyopathy and severe heart failure.

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Superior vena cava stenosis presenting with bendopnea

BMJ Case Reports ◽

10.1136/bcr-2021-242418 ◽

2021 ◽

Vol 14 (4) ◽

pp. e242418

Author(s):

Mozhu Li ◽

Seth Toomay ◽

Mark H Drazner ◽

Jennifer T Thibodeau

Keyword(s):

Heart Failure ◽

Differential Diagnosis ◽

Superior Vena Cava ◽

Superior Vena ◽

Vena Cava ◽

Ventricular Filling ◽

Vena Cava Stenosis ◽

Superior Vena Cava Stenosis

Bendopnea, or dyspnoea with bending forward, is a recently described symptom of heart failure that is associated with elevated ventricular filling pressures. Here, we describe a case of superior vena cava (SVC) stenosis that presented with bendopnea and resolved with SVC recanalisation. We suggest that SVC stenosis be considered in the differential diagnosis of patients who experience bendopnea.

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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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