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Persistent left superior vena cava (PLSVC) is the most common congenital abnormality of the thoracic systemic venous drainage; in fact, cardiology fellows in training are often quizzed on this when a dilated coronary sinus is noted on an echocardiogram. However, its association with an absent right superior vena cava (RSVC) and how to diagnose this combined condition is less commonly known. We present two cases of PLSVC with an absent RSVC, describe how to recognize and confirm this diagnosis, and discuss its clinical relevance. [ABSTRACT FROM AUTHOR]

Introduction: Venous anomalies of the thorax can involve systemic or pulmonary veins and range from isolated incidental findings to components of more complex anomalies, most often congenital heart disease (CHD). Although echocardiography and catheter directed cardiac angiography are generally accepted as the primary imaging techniques for evaluation of CHD, CT and MRI are important complementary diagnostic tools. Multi-detector computed tomography (MDCT) with its increasing availability and utility is now becoming a further method of imaging CHD. In light of its widespread availability, MDCT and 3D imaging are increasingly considered as a viable "one-stop shop" for preoperative imaging evaluation of cardiovascular structures in selected pediatric patients. Aim of the work: The aim of this work is to evaluate the role of MDCT in visualization of the thoracic venous system in pediatrics with congenital heart disease, show prevalence and types of venous anomalies and to compare this data with echocardiographic findings. Methods: The studied group included 30 cases referred to us by pediatric cardiologists to be examined by MSCT angiography of the heart and thoracic vessels. All the patients were known cases of congenital heart disease and underwent echocardiography. They were referred to answer specific anatomic question raised by inconclusive echocardiography, to assess suspected systemic and suspected pulmonary venous anomalies. All patients were subjected to full history taking, clinical examination and MDCT examination with CT lightspeed VCT XT 64-detectors row scanner (General Electric, Medical Systems, Milwaukee, Wisconsin, USA). Results: CTA findings had 77.8 % concordance with echocardiographic findings regarding SVC anomalies, 66.7 % concordance with echocardiography regarding IVC anomalies and 90 % concordance regarding pulmonary venous anomalies. Conclusion: Low dose protocol CTA is a promising method that complementary to Echocardioraphy for imaging of extracardiac vascular structures in pediatrics with congenital heart diseases. [ABSTRACT FROM AUTHOR]

Objective: Moderate to severe aortic regurgitation is occurring in 20% to 30% of cases after transcatheter aortic valve implantation. Methods: The purpose of the study was to investigate the impact of a prospective policy of “oversizing” the Edwards SAPIEN bioprosthesis (Edwards Lifesciences LLC, Irvine, Calif) relative to the diameter of the aortic annulus on the rate and severity of aortic regurgitation in 28 consecutive patients initially considered eligible for transcatheter aortic valve implantation on the basis of angiography, multislice computed tomography, and transthoracic echocardiography. This policy included the systematic use of transesophageal echocardiography to exclude borderline patients and the modification of the procedure to use the larger device possible. The results were studied on an individual patient basis. Results: Because 6 of 28 patients (21%) had an annulus diameter greater than 24 mm by transesophageal echocardiography, 22 patients underwent implantation of the Edwards SAPIEN prosthesis. In 6 of 22 patients, the procedure was adapted to follow our “oversizing” policy. As a result, the “prosthesis/annulus cover index” was 12.4% ± 4.3%. The procedure was successful in 21 of 22 patients (95%), and 18 patients were available for echocardiography at 1 month. Although a moderate to severe aortic regurgitation was observed pretreatment in 4 of 18 patients (22%), it was no longer the case at 1 month (0/18, 0%; P = .03). The improvement was secondary to a disappearance of the aortic regurgitation in all 7 patients with a significant aortic regurgitation at pretreatment, whereas the new aortic regurgitations appearing in 5 of the 11 patients with no aortic regurgitation at pretreatment were only mild aortic regurgitations. Conclusions: In patients with a successful implantation of an Edwards SAPIEN valve, a simple “oversizing” policy based on a systematic use of transesophageal echocardiography and modification of the procedure may prevent the occurrence of moderate and severe aortic regurgitations. [Copyright &y& Elsevier]

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 chest CT. The anatomy was unique as there was anomalous left hepatic vein drainage into the right atrium. The case provides insight into the diagnostic modalities and clinical considerations of this unusual thoracic venous anomaly. [ABSTRACT FROM AUTHOR]