Superior vena cava draining into left atrium

Tuchman, Herman; Brown, John F.; Huston, John H.; Weinstein, Arvin B.; Rowe, George G.; Crumpton, Charles W.

doi:10.1016/0002-9343(56)90047-x

Cited by 58 publications

(6 citation statements)

References 5 publications

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“…The functional symptomatology produced by a superior caval vein draining to the left atrium consists mostly of dyspnoea due to right-to-left shunting, causing hypoxaemia and cyanosis. The severity depends on the precise anatomical arrangement, 2,4,[6][7][8] being maximal when the venous drainage from the upper body is exclusively via the left superior caval vein into the left atrium, representing approximately two-fifths of the total systemic venous return. On frontal chest roentgenography, the upper mediastinum may be widened by an opacity crossing the aortic arch, corresponding to the left superior caval vein, and associated, as in our patient, with mild cardiomegaly, 3,4 though the radiograph may be completely normal.…”

Section: Discussionmentioning

confidence: 99%

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Diagnosis, management, and follow-up of systemic venous drainage via a single left superior caval vein into the left atrium

2006

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A 15-month-old boy presented with asymptomatic hypoxaemia due to right-to-left venous shunting via a left superior caval vein emptying into the left atrium, in absence of right superior caval vein. The diagnosis, suspected by contrast echocardiography, was confirmed by computed tomography and angiography. The child underwent surgical correction of the systemic anomalous return by tunnelling the left superior caval vein towards the right atrium. An asymptomatic narrowing inside the intra-atrial baffle developed 6 months later.

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Section: Discussionmentioning

confidence: 99%

“…Isolated drainage of a left superior caval vein into the left atrium, in absence of either another congenital cardiac malformation or a right superior caval vein, is much rarer. [3][4][5][6][7] In this report, we present a new case, describing its management and clinical evolution.…”

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confidence: 99%

Diagnosis, management, and follow-up of systemic venous drainage via a single left superior caval vein into the left atrium

2006

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“…A right-sided SVC that drains into the left atrium is a very rare congenital abnormality, and reports of only seven cases could be found in the English-language medical literature (13)(14)(15)(16)(17)(18)(19). The SVC may drain into or receive drainage from one or more pulmonary veins before entering the left atrium (8).…”

Section: Discussionmentioning

confidence: 99%

Case 74: Right-sided Superior Vena Cava Draining into Left Atrium in a Patient with Persistent Left-sided Superior Vena Cava

Pretorius¹,

Gleeson²

2004

Radiology

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A 61-year-old man with hypogammaglobulinemia presented with recent onset of shortness of breath and pleuritic chest pain. He was slightly cyanotic. Results of an examination of the chest and cardiovascular system were unremarkable. There was no history of cardiac disease. A chest radiograph showed a few small areas of peripheral airspace opacity. Perfusion lung scintigraphy was performed to assist in the evaluation of pulmonary embolism after injection of technetium 99m ( 99m Tc) macroaggregated albumin (MAA) into a right arm vein. Given the findings of this examination, contrast material-enhanced computed tomography (CT) of the chest was performed on the same day. A 100-mL dose of iopamidol 300 was injected into a right arm vein at a rate of 4 mL/sec, and image acquisition commenced 20 seconds after the start of the injection. Another episode of pleuritic chest pain prompted another perfusion examination 19 days later. This time, 99m Tc-MAA was injected into a left arm vein. IMAGING FINDINGSThe first perfusion lung scintigram, obtained after 90 MBq of 99m Tc-MAA was injected into a right arm vein, shows activity predominantly in the systemic arterial perfusion territoryparticularly in the brain, kidneys, spleen, thyroid, bowel, and myocardium-which indicates a right-to-left shunt (Fig 1). A chest CT scan obtained after contrast material was injected into a right arm vein confirms a right-to-left shunt caused by the right-sided superior vena cava (SVC) draining into the left atrium (Fig 2). In addition, this CT scan shows a persistent left-sided SVC.A second perfusion lung scintigram was obtained 19 days after the first scintigram was obtained, with injection of a radiotracer into a left arm vein. The appearance of the second scintigram was normal, with no evidence of pulmonary embolism or systemic shunting (Fig 3). DISCUSSIONThe key to establishing a diagnosis lies in reconciling the discordant findings on the two perfusion lung scintigrams by identifying and interpreting two vascular anomalies on the CT scan.The first perfusion lung scintigram (Fig 1) was obtained by injecting the radiotracer into a right arm vein, and the systemic distribution of activity indicates a right-to-left shunt. Visual estimation of the amount of activity in the systemic circulation versus the pulmonary circulation suggests a highgrade shunt, which is at odds with the patient's mild cyanosis and asymptomatic survival into middle age.The contrast-enhanced chest CT scan (Fig 2), which was obtained by injecting contrast material into a right arm vein, confirmed a right-to-left shunt, which was caused by the anomalous drainage of the right-sided SVC into the left atrium. This results in complete right-to-left shunting of the venous return from the right arm and right jugular territories. This shunt explains the systemic distribution of radiotracer that is seen on the first perfusion lung scintigram and the marked paucity of activity in the lungs. The small amount of activity observed in the lungs can be explained on the basis of the bronc...

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“…Partial or total anomalous pulmonary venous connections are usually associated with sinus venosus type ASD and reported in only 10% of patients with secundum type ASD [1]. Anomalous venous connections between superior caval vein and left atrium or inferior caval vein and left atrium are rarely associated with ASD [2][3][4][5][6]. Furthermore, extracardiac vascular tunnels between left and right atrium in patients with ASD have not been previously reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

‘Natural Conduit’ between two atria associated with atrial septal defect

Kanadaşı

Özbarlas

Demirtaş

et al. 2005

Int J Cardiovasc Imaging

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Herein, we present a case of 46 years old woman with an extracardiac venous connection between two atria associated with secundum type atrial septal defect (ASD). This interatrial tunnel was not recognized by both transthoracic and transesophageal echocardiographic examinations. Computed tomography suspected a blood flow from right inferior pulmonary vein to inferior caval vein. Consequently, the patient underwent cardiac catheterization. Angiography revealed a tunnel between left and right atrium. To our knowledge, this is the first report of a case with venous tunnel between two atria associated with secundum type ASD in the literature.

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Superior vena cava draining into left atrium

Cited by 58 publications

References 5 publications

Diagnosis, management, and follow-up of systemic venous drainage via a single left superior caval vein into the left atrium

Diagnosis, management, and follow-up of systemic venous drainage via a single left superior caval vein into the left atrium

Case 74: Right-sided Superior Vena Cava Draining into Left Atrium in a Patient with Persistent Left-sided Superior Vena Cava

‘Natural Conduit’ between two atria associated with atrial septal defect

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