Transcatheter closure of large persistent left superior vena cava causing cyanosis in two patients post‐Fontan operation utilizing the Gianturco Grifka vascular occlusion device

Recto, Michael R.; Elbl, Francisco; Austin, Erle H.

doi:10.1002/ccd.1190

Cited by 15 publications

(16 citation statements)

References 11 publications

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“…[6][7][8] This variant poses the greatest potential of hazards with central venous catheter (CVC) placement as there is a high chance of systemic embolization of air, thrombus, or tissue debris with cannulation of the PLSVC. 17,18,21 The presence of PLSVC may complicate surgical repair of these congenital heart defects. Because the hemodynamics of venous return are altered by PLSVC, cannulation and perfusion techniques during formation and conduction.…”

Section: Diagnosismentioning

confidence: 99%

“…In the remaining 8%, cardiopulmonary bypass (CPB) must accommodate the changes imposed by this anomaly. 5,13,21 Placing a CVC or access through PLSVC might pose several serious problems. 6,11,21 There have been several reports of hypotension, angina, arrhythmias, and even cardiac arrest as a result of manipulation of the coronary sinus.…”

Section: Diagnosismentioning

confidence: 99%

“…5,13,21 Placing a CVC or access through PLSVC might pose several serious problems. 6,11,21 There have been several reports of hypotension, angina, arrhythmias, and even cardiac arrest as a result of manipulation of the coronary sinus. It can also make placement of pacemaker leads and pulmonary artery catheters difficult because of the orientation of coronary sinus.…”

Section: Diagnosismentioning

confidence: 99%

“…It can also make placement of pacemaker leads and pulmonary artery catheters difficult because of the orientation of coronary sinus. 11,[21][22][23] Besides being associated with congenital diseases, PLSVC's most relevant clinical implication is the association with disturbances of cardiac impulse PLSVC drains into the left atrium creating a left to right shunt. [6][7][8][9][10] This lesion usually has little hemodynamic effect, although a variable degree of systemic cyanosis and clubbing may be seen.…”

Section: Diagnosismentioning

confidence: 99%

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Persistent left superior vena cava (PLSVC) with anomalous left hepatic vein drainage into the right atrium: role of imaging and clinical relevance

et al. 2007

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An 86-year-old white male with a history of inferior wall myocardial infarction 25 years ago, chronic atrial fibrillation and hyperlipidemia presented with shortness of breath, dizziness of several weeks' duration, and chronic stable angina. Physical exam was remarkable for bradycardia with regular rhythm and normal S1 and S2 with a systolic ejection murmur. ECG on admission showed complete heart block with a ventricular rate of 37 beats/min. Cardiac biomarkers were negative. His heart rate then decreased to 29 beats/min and atropine 0.5 mg followed by 1 mg was given without any response.During pacemaker implantation a fluoroscopic examination of the thoracic anatomy demonstrated normal structure. Initially, the left subclavian vein approach was employed. Multiple attempts to locate the left subclavian vein percutaneously in the usual infra-clavicular fashion under fluoroscopic guidance were not successful. Therefore, a left brachial venogram was performed using 15 cc of nonionic contrast injected into the left antecubital vein. The cineangiogram demonstrated patency of the subclavian vein but with very slow flow and a suggestion of a vertical course of the subclavian vein along the left mediastinum. The left brachial vein was accessed using a micropuncture needle and a flexible guide wire was advanced which confirmed the suspicion of a persistence of left superior vena cava (Figure 1). Therefore, the left subclavian vein approach for the pacing lead insertion was abandoned. Next, under fluoroscopic guidance, the right subclavian vein was accessed with the micropuncture needle followed by placement of a guide wire into the right atrium without difficulty.Echocardiography showed markedly dilated left and right atria (8.9 ϫ 8.1 cm, 9.3 ϫ 8.5 cm, respectively) with an intact interatrial septum. An enlarged coronary sinus draining into the right atrium was observed. Abstract: Persistent left superior vena cava (PLSVC) is a very rare and yet the most commonly described thoracic venous anomaly in medical literature. It has a 10-fold higher incidence with congenital heart disease. PLSVC often becomes apparent when an unknown PLSVC is incidentally discovered during central venous line placement, intracardiac electrode/pacemaker placement or cardiopulmonary bypass, where it may cause technical difficulties and life-threatening complications. PLSVC is also associated with disturbances of cardiac impulse formation and conduction including varying degrees of heart blocks, supraventricular arrhythmias and Wolff Parkinson White syndrome. We describe the case of an 86-year-old male with a history of coronary artery disease and chronic atrial fibrillation who presented with worsening dyspnea and syncopal episodes. An ECG was consistent with complete heart block. During lead placement for the pacemaker, a left subclavian approach was unsuccessful. A left venogram was performed through the brachial vein that demonstrated a left superior vena cava. The diagnosis was confirmed with echocardiography using a bubble study and also a c...

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

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Persistent left superior vena cava (PLSVC) with anomalous left hepatic vein drainage into the right atrium: role of imaging and clinical relevance

et al. 2007

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“…However, these vessels may become quite large and require more substantial devices possibly in combination with coils to achieve full occlusion. 3 We describe what appears to be the first such case where an Amplatzer duct occluder device was successfully deployed in such clinical situation. Two adolescents who previously had undergone a Fontan procedure presented late with increasing desaturation secondary to progressive enlargement of a persistent left superior vena cava (LSVC) draining into the pulmonary venous circulation.…”

Section: Introductionmentioning

confidence: 96%

Transcatheter Closure of Dilated Left Superior Vena Cava for Resolution of Late Cyanosis Following Fontan Palliation

Abdullah

Menahem

2006

Heart, Lung and Circulation

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References

2003

The Natural and Modifed History of Congenital Heart Disease

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Transcatheter closure of large persistent left superior vena cava causing cyanosis in two patients post‐Fontan operation utilizing the Gianturco Grifka vascular occlusion device

Cited by 15 publications

References 11 publications

Persistent left superior vena cava (PLSVC) with anomalous left hepatic vein drainage into the right atrium: role of imaging and clinical relevance

Persistent left superior vena cava (PLSVC) with anomalous left hepatic vein drainage into the right atrium: role of imaging and clinical relevance

Transcatheter Closure of Dilated Left Superior Vena Cava for Resolution of Late Cyanosis Following Fontan Palliation

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