Results of radiofrequency ablation of ectopic atrial tachycardia originating from the left superior vena cava in a patient with congenital heart disease

Persistent left superior vena cava (PLSVC) is the most common anomaly of the thoracic veins (occurs in 0.2-0.6% of cases in the general population), in the vast majority of cases, PLSVC drains into the right atrium through the dilated coronary sinus and usually does not lead to significant hemodynamic disorders. The presence of PLSVC is often associated with cardiac arrhythmias; in this clinical case, we present the results of catheter ablation of arrhythmogenic foci in a 72-year-old patient with continuous-recurring ectopic tachycardia originating from the PLSVC.

An Unusual Case of Dilated Coronary Sinus: Case Report and Clinical Implications

BACKGROUND The presence of a dilated coronary sinus (CS) assessed by echocardiography (TTE) is highly suggestive of inferior or superior vena cava anomalies, in the absence of a shunt. The most frequent finding is the persistence of a left superior vena cava (LSVC): well-known feature to electrophysiologists. Abnormal inferior vena cava (IVC) drainage is another cause of CS dilatation. CASE SUMMARY An 83-year-old woman presented with heart failure symptoms, atrial fibrillation with rapid ventricular rate and a dilated CS assessed by TTE. Atrioventricular (AV) node ablation was considered given the poor efficacy of a rate-control strategy. Cardiac computed tomography (CT) revealed a double superior vena cava with a LSVC draining directly into the dilated CS. Single-lead pacemaker implantation was performed using a right-side vascular access with no technical difficulties. An aborted AV node ablation procedure was due to the impossibility of getting to the right atrium. Fluoroscopy and CT imaging at second-look analysis confirmed the diagnosis of an abnormal IVC with an agenesia of its supra-hepatic segment directly drained into the CS. DISCUSSION Our clinical case illustrates an unusual and rare double venous abnormality: both LSVC and IVC directly drained into the CS and were responsible for its massive dilatation.

Tricuspid atresia type 1B with left superior vena cava in a 4-month-old child: An unusual combination diagnosed by transthoracic echocardiography

Tricuspid atresia (TA) is a rare cyanotic congenital heart disease. A persistent left superior vena cava (LSVC) may be associated with TA. The presence of LSVC raises important considerations for eventual repair, in that it may lead to persistent arterial desaturation even after corrective surgery, if associated with an unroofed coronary sinus. Here, we present the case of a 4-month-old child who was diagnosed with TA type 1B, LSVC and a dilated coronary sinus by transthoracic echocardiography.

Tricuspid atresia type 1B with left superior vena cava in a 4-month-old child: An unusual combination diagnosed by transthoracic echocardiography

Tricuspid atresia (TA) is a rare cyanotic congenital heart disease. A persistent left superior vena cava (LSVC) may be associated with TA. The presence of LSVC raises important considerations for eventual repair, in that it may lead to persistent arterial desaturation even after corrective surgery, if associated with an unroofed coronary sinus. Here, we present the case of a 4-month-old child who was diagnosed with TA type 1B, LSVC and a dilated coronary sinus by transthoracic echocardiography.

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

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.

Dilated Coronary Sinus: An Indicator of Persistent Left Superior Vena Cava

An 88-year-old male presented for a routine transthoracic echocardiogram. Dilated coronary sinus was noted, raising the suspicion for persistent left superior venous cava (PLSVC). An agitated saline study from the left upper extremity demonstrated a flow through the coronary sinus into the right ventricle in a parasternal long-axis view. A venogram from the right internal jugular vein showed the PLSVC drained into a much dilated coronary sinus (CS) that connected to the right atrium. The right superior vena cava was absent. PLSVC along with absent right superior vena cava is rare and the inadvertent CS cannulation may result in vessel perforation.