Accurate placement of the distal end of a ventriculoatrial shunt with the aid of real-time transesophageal echocardiography

2006 ◽  
Vol 105 (1) ◽  
pp. 153-156 ◽  
Author(s):  
Theofilos G. Machinis ◽  
Kostas N. Fountas ◽  
John Hudson ◽  
Joe Sam Robinson ◽  
E. Christopher Troup
Keyword(s):  
Transesophageal Echocardiography ◽  
Real Time ◽  
Superior Vena Cava ◽  
Right Atrium ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Distal Catheter ◽  
The Mean ◽  
The Right

Objective Ventriculoatrial (VA) shunts remain a valid option for the treatment of hydrocephalus, especially in patients in whom ventriculoperitoneal (VP) shunts fail. Correct positioning of the distal end of the catheter in the right atrium is of paramount importance for maintaining shunt patency and reducing the incidence of VA shunt-associated morbidity. The authors present their experience with real-time transesophageal echocardiography (TEE) monitoring for the accurate placement of the distal catheter of a VA shunt. Methods Four patients underwent conversion of a VP shunt to a VA shunt under the guidance of intraoperative fluoroscopy and TEE between May 2003 and December 2004. After induction of general anesthesia, the TEE transducer was advanced into the esophagus. A cervical incision was made and the external jugular vein was visualized. An introducer was passed through an opening in the jugular vein and a guidewire was placed through the introducer. Under continuous TEE guidance, the guidewire was carefully advanced into the superior vena cava. A distal shunt catheter overlying a J-wire was then passed to the superior vena cava, again under TEE guidance. The catheter was advanced to the right atrium after removing the guidewire. Final visualization with TEE and fluoroscopy revealed a good position of the catheter in the right atrium in all four cases. The mean duration of the operation was 91 minutes (range 65–120 minutes) and the mean operative blood loss was 23 ml (range 10–50 ml). No procedure-related complication was noted. Conclusions Real-time TEE is a safe and simple technique for the accurate placement of the distal catheter of a VA shunt.

Catheterization of a Persistent Left Superior Vena Cava

2009 ◽  
Vol 10 (3) ◽  
pp. 214-215 ◽  
Author(s):  
Lúcia F. Parreira ◽  
Carlos C. Lucas ◽  
Célia C. Gil ◽  
José D. Barata
Keyword(s):  
Superior Vena Cava ◽  
Right Atrium ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
Fetal Life ◽  
Left Internal Jugular Vein ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
The Right

Patency of the left superior vena cava, although uncommon, is the most frequent anomaly of the thoracic vessels. It has been diagnosed in 0.3–0.5% of the general population. A persistent left superior vena cava (PLSVC) results from the abnormal persistence of an embryological vessel that normally involutes into the coronary sinus during fetal life. Catheterization of this vessel, including hemodialysis (HD) catheter placement, appears to be safe if adequate drainage of the PLSVC to the right atrium exists. We present the case of a 50-year-old HD patient in which the placement of a catheter through the left internal jugular vein, needed for HD treatment, revealed a PLSVC. After the demonstration of adequate draining of the vessel into the right atrium, replacement of this catheter for a cuffed tunneled HD catheter was done, which has since been used successfully for HD.

scholarly journals P649 Before and after: sinus venosus atrial septal defect

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.

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

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.

scholarly journals Aplasia of the superior vena cava and persistent superior left vena cava in a 3-year-old child: Case report

2021 ◽  
Vol 11 (1) ◽  
pp. 85-90
Author(s):  
Vladimir V. Lazarev ◽  
Tatiana V. Linkova ◽  
Pavel M. Negoda ◽  
Anastasiya Yu. Shutkova ◽  
Sergey V. Gorelikov ◽  
...  
Keyword(s):  
Case Report ◽  
Internal Jugular Vein ◽  
Superior Vena Cava ◽  
Vascular Access ◽  
Vascular System ◽  
Jugular Vein ◽  
Superior Vena ◽  
Vena Cava ◽  
X Ray ◽  
The Right

BACKGROUND: Structural features of the patients vascular system can cause unintended complications when providing vascular access and can disorient the specialist in assessing the location of the installed catheter. This study aimed to demonstrate anatomical features of the vascular system of the superior vena cava and diagnostic steps when providing vascular access in a child. CASE REPORT: Patient K (3 years old) was on planned maintenance of long-term venous access. Preliminary ultrasound examination of the superior vena cava did not reveal any abnormalities. Function of the right internal jugular vein under ultrasound control was performed without technical difficulties; a J-formed guidewire was inserted into the vessel lumen. X-ray control revealed its projection in the left heart, which was regarded as a technical complication, so the conductor was removed. A further attempt to insert a catheter through the right subclavian vein led to the same result. For a more accurate diagnosis, the child underwent computed angiography of the superior vena cava system. Congenital anomalies of the vascular system included aplasia of the superior vena cava and persistent left superior vena cava. Considering the information obtained, the Broviac catheter was implanted under ultrasound control through the left internal jugular vein without technical difficulties with the installation of the distal end of the catheter into the left brachiocephalic vein under X-ray control. CONCLUSION: A thorough multifaceted study of the vascular anatomy helps solve the anatomical issues by ensuring vascular access and preventing the risks of complications.

Persistent left superior vena cava and its clinical correlation - A cadaveric study

2021 ◽  
Vol 12 (4) ◽  
pp. 118-121
Author(s):  
Sachendra Kumar Mittal ◽  
Rekha Parashar ◽  
Pankaj Kumar Singh ◽  
Leena Jadon
Keyword(s):  
Superior Vena Cava ◽  
Right Atrium ◽  
Superior Vena ◽  
Vena Cava ◽  
Medical Sciences ◽  
Left Superior Vena Cava ◽  
Persistent Left Superior Vena ◽  
Male Cadaver ◽  
The Right ◽  
Brachiocephalic Veins

Background: Presented is a case of persistent left superior vena cava draining into the right atrium through coronary sinus and finally opens into right atrium. Abnormalities of the vascular system are more commonly seen due to its importance in circulation. Persistent left superior vena cava is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress.The venous anomaly of a persistent left superior vena cava (PLSVC) affects 0.3%–0.5% of the general population. Normally the superior vena cava is a single vascular structure formed by the union of right and left brachiocephalic veins which are in turn formed by the union of internal jugular and subclavian veins of corresponding side, draining the head and neck as well as the superior extremity. Aims and Objective: To evaluate the accuracy of persistent left superior vena cava and to find out the opening of PLSVC and formations of both SVC. Materials and Methods: During routine dissection of Thorax, we have opened the thoracic cage and take out the Heart. during that we found separate SVC and then we did the study on this PLSVC in the Department of Anatomy, Jaipur National University Institute for Medical Sciences and Research Centre (JNUIMSRC) Jaipur and National Institute of Medical Sciences and Research (NIMS & R). Results: We found persistent left superior vena cava in two cadavers out of 30 cadavers (6.66%) one was 64-year-old male cadaver and another 72-year-old male cadaver. Both the vena cavae were formed as of brachiocephalic veins of the corresponding side. The persistent left superior vena cava opened into the enlarged coronary sinus that drained into the right atrium between the opening of inferior vena cava and right atrio-ventricular orifice. Conclusion: It has important clinical implications in certain clinical interventions. It may complicate placementof cardiac catheters or pacemaker leads.

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