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The Annals of Thoracic Surgery Jul 2021In stage III to IVa thymic epithelial tumors (TETs), infiltration of the superior vena cava (SVC) is not rare. The extent of SVC resection depends on the width of the...
BACKGROUND
In stage III to IVa thymic epithelial tumors (TETs), infiltration of the superior vena cava (SVC) is not rare. The extent of SVC resection depends on the width of the area of neoplastic invasion. Our article aims to evaluate the safety and long-term outcomes of extended thymectomy for TETs with SVC resection compared with advanced-stage TETs patients without SVC resection.
METHODS
Retrospective review of the experience on patients who underwent extended thymectomy for TETs in the last 20 years, according to STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) methodology. Progression-free survival (PFS) and overall survival (OS) were calculated using the Kaplan-Meier method. A backward stepwise Cox regression multivariate analysis was performed to determine factors associated with long-term outcomes.
RESULTS
A total of 78 patients underwent surgery for advanced-stage TETs (Masaoka-Koga stages III-IVa) from January 1998 to April 2019. Fourteen (17.9%) underwent thymectomy with resection of SVC. Presence of a thymic carcinoma (hazard ratio , 2.26; 95% confidence interval, 1.82-6.18; P = .038) and the SVC resection (hazard ratio, 1.89; 95% confidence interval, 1.11-3.96; P = .041) were adverse prognostic factors at multivariate analysis. The median OS and the PFS of all SVC resected patients were 50 (range, 5-207) months and 31 (range, 5-151) months, respectively. There was no significant difference in OS (P = .28) and PFS (P = .32) between SVC-resected and non-SVC-resected patients.
CONCLUSIONS
SVC resection is a safe and effective procedure to restore the venous system continuity and does not seem to affect survival and disease recurrence. This surgical approach allows radical resection of locally advanced TETs, even after neoadjuvant chemotherapy.
Topics: Adult; Female; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasms, Glandular and Epithelial; Pneumonectomy; Progression-Free Survival; Proportional Hazards Models; Retrospective Studies; Thymectomy; Thymus Neoplasms; Vena Cava, Superior
PubMed: 33068543
DOI: 10.1016/j.athoracsur.2020.07.069 -
The British Journal of Radiology Feb 2021Deviations from the normal process of embryogenesis can result in various developmental anomalies of the superior vena cava (SVC). While these anomalies are often... (Review)
Review
Deviations from the normal process of embryogenesis can result in various developmental anomalies of the superior vena cava (SVC). While these anomalies are often asymptomatic, they assume clinical importance during interventions such as central venous catheterisations and pacemaker implantations and during cardiothoracic surgeries while instituting cardiopulmonary bypass and for creation of cavo-pulmonary connections. Role of imaging in identifying these anomalies is indispensable. Cross-sectional imaging techniques like CT venography and magnetic resonance (MR) venography allow direct visualisation and consequently increased detection of anomalies. CT venography plays an important role in detection of SVC anomalies as it is readily available, has excellent spatial resolution, short acquisition times and potential for reconstruction of images in multiple planes. This pictorial review focuses on the developmental anomalies of the SVC and its tributaries highlighting their embryological basis, imaging appearances on CT venography and potential clinical implications, where relevant.
Topics: Computed Tomography Angiography; Humans; Magnetic Resonance Angiography; Phlebography; Radiologists; Vena Cava, Superior
PubMed: 33197326
DOI: 10.1259/bjr.20200856 -
Actas Dermo-sifiliograficas May 2021
Topics: Humans; Superior Vena Cava Syndrome; Vena Cava, Superior
PubMed: 33220310
DOI: 10.1016/j.ad.2019.09.009 -
Annals of Cardiac Anaesthesia 2023A patient with Marfan syndrome undergoing Bentall operation was found to have an absent right superior vena cava and persistent left superior vena cava. The dilation of...
A patient with Marfan syndrome undergoing Bentall operation was found to have an absent right superior vena cava and persistent left superior vena cava. The dilation of coronary sinus raised the suspicion of persistent left superior vena cava. The diagnosis was confirmed by agitated saline contrast echocardiography and computed tomography of the chest.
Topics: Humans; Persistent Left Superior Vena Cava; Vena Cava, Superior; Incidental Findings; Echocardiography; Coronary Sinus
PubMed: 37861579
DOI: 10.4103/aca.aca_91_23 -
The Journal of International Medical... Jan 2021Cardiac implantable devices are commonly used for superior vena cava stenosis, but there have been few reports of electrode replacement in the stenosed superior vena...
Cardiac implantable devices are commonly used for superior vena cava stenosis, but there have been few reports of electrode replacement in the stenosed superior vena cava. A 73-year-old man was diagnosed with second-degree type II atrioventricular block and a permanent dual-chamber, rate-modulated pacing pacemaker was implanted 10 years previously. Because of depletion of the pacemaker battery and an increase in the ventricular pacing threshold, replacement of the pacemaker and ventricular electrode was required. During the operation, we found that the patient had severe superior vena cava stenosis on angiography, and this caused obstruction when a common guidewire was used to pass through the superior vena cava. After attempting various methods, we successfully passed through the vascular stenosis with a super slide guidewire and a long sheath, and completed replacement of the pacemaker and ventricular electrode. We summarize the related literature of superior vena cava stenosis related to a cardiac implantable device, and discuss the replacement strategy of this complication and other treatment options.
Topics: Aged; Atrioventricular Block; Cardiac Pacing, Artificial; Constriction, Pathologic; Humans; Male; Pacemaker, Artificial; Vena Cava, Superior
PubMed: 33445982
DOI: 10.1177/0300060520945170 -
Journal of Thoracic Oncology : Official... Jan 2020
Topics: Humans; Lung Neoplasms; Superior Vena Cava Syndrome; Vena Cava, Superior
PubMed: 31605796
DOI: 10.1016/j.jtho.2019.09.010 -
Archives of Cardiovascular Diseases Feb 2019Left superior vena cava draining into the left atrium in the absence of coronary sinus is an anomaly that can appear in heterotaxy syndrome and unroofed coronary sinus...
Left superior vena cava draining into the left atrium in the absence of coronary sinus is an anomaly that can appear in heterotaxy syndrome and unroofed coronary sinus syndrome. Regardless of the origin of these syndromes, biventricular repair can be done through rerouting by intracardiac procedures or through disconnection-reconnection of the left superior vena cava to the right atrium or right superior vena cava by extracardiac procedures. Different techniques can be used for this purpose, each of which has its own advantages and limitations. Therefore, appropriate selection is necessary to obtain the best results for each patient, and many factors, such as patient anatomy, age, associated cardiomyopathies, etc., have to be considered. In this review, we focus on heterotaxy and unroofed coronary sinus syndromes, associated cardiomyopathies, the state-of-the-art in their surgical treatment and our results in a sample of 10 patients. Our experience highlights the importance of accurate diagnosis and specific selection of surgical technique for the management of biventricular repair in patients with left superior vena cava draining into the left atrium in the absence of coronary sinus.
Topics: Adolescent; Cardiac Surgical Procedures; Child; Child, Preschool; Coronary Angiography; Coronary Sinus; Echocardiography, Doppler, Color; Female; Heart Atria; Heterotaxy Syndrome; Humans; Infant; Male; Middle Aged; Treatment Outcome; Vena Cava, Superior
PubMed: 30181052
DOI: 10.1016/j.acvd.2018.05.007 -
Deutsches Arzteblatt International Sep 2021
Topics: Humans; Stents; Superior Vena Cava Syndrome; Vena Cava, Superior
PubMed: 34857081
DOI: 10.3238/arztebl.m2021.0064 -
Journal of Cardiology Apr 2020The safety and efficacy of superior vena cava (SVC) isolation (SVCI) using second-generation cryoballoon (CB) ablation remains unknown.
BACKGROUND
The safety and efficacy of superior vena cava (SVC) isolation (SVCI) using second-generation cryoballoon (CB) ablation remains unknown.
METHODS
Electrical isolation of SVC was attempted using the second-generation CB ablation catheter in 14 canines. Ablation duration was randomized to either 90 s (7 canines) or 120 s (7 canines). SVC venography was performed to identify the SVC-right atrium (RA) junction. The 28-mm CB was positioned above SVC-RA junction. Repeat electrophysiological assessment in the live animals was conducted 40-60 days post-ablation, after which animals were euthanized for histological examination.
RESULTS
Acute SVCI was successfully performed in all canines. No significant differences in numbers of freezes (1.7 ± 0.8 vs. 1.5 ± 0.5, p = 0.658), time to isolation (TTI) (24.3 ± 8.1s vs. 22.7 ± 9.0s, p = 0.297), temperature at isolation (-23.4 ± 12.5 °C vs. -21.5 ± 11.1 °C, p = 0.370), and nadir temperature (-51.2 ± 6.2 °C vs. -53.3 ± 7.0 °C, p = 0.195) were observed between the 90-s and 120-s groups. There were no procedural complications except one transient sinus bradycardia in the 120-s group. After ablation, animals survived for 51 ± 5 days. Chronic SVCI was achieved in 6 of 7 (85.7%) SVCs in the 90-s group and 7 of 7 SVCs (100%) in the 120-s group (p = 0.299). Histological analysis revealed that a circumferential transmural lesion was achieved in all isolated SVCs. No sinus node (SN) and phrenic nerve injuries were observed. The minimum distance between ablation lesion and SN was 5.1 ± 3.0 mm.
CONCLUSIONS
The second-generation CB ablation catheter is both safe and effective in achieving SVC isolation in a canine model. Effective SVCI was found in the 90-s dosing strategy.
Topics: Animals; Dogs; Catheter Ablation; Cryosurgery; Heart Atria; Models, Animal; Vena Cava, Superior
PubMed: 31522792
DOI: 10.1016/j.jjcc.2019.08.013 -
Folia Morphologica 2022Abnormal systemic vein development produces anomalous veins, which - in the case of persistent left superior vena cava and/or left brachiocephalic vein - exhibit...
Double superior vena cava and left brachiocephalic vein agenesis: a rare systemic vein anomaly and potential source of cardiac implantable electronic device and central venous catheter placement complications.
Abnormal systemic vein development produces anomalous veins, which - in the case of persistent left superior vena cava and/or left brachiocephalic vein - exhibit considerable topographic and morphometric differences in comparison with their usual anatomy. The nature and extent of those developmental anomalies - detected during intravenous procedures, such as cardiac implantable electronic device (CIED) lead insertion or central venous catheter placement - may hinder the procedure itself and/or adversely affect its outcome, both at the stage of cardiac lead advancement through an abnormally shaped vessel and lead positioning within the heart. This may lead to problems in achieving optimal sensing and pacing parameters and in ensuring that the patient cannot feel the pacing impulses. These events accompanied a de novo CIED implantation procedure in the patient with a double superior vena cava and left brachiocephalic vein agenesis, who ultimately required reoperation.
Topics: Humans; Vena Cava, Superior; Brachiocephalic Veins; Central Venous Catheters; Vascular Malformations; Heart
PubMed: 34699053
DOI: 10.5603/FM.a2021.0108