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Journal of Interventional Cardiac... Dec 2021Paroxysmal atrial fibrillation (PAF) can be triggered by non-pulmonary vein foci, like the superior vena cava (SVC). The latter is correlated with improved result in...
Comparison between superior vena cava ablation in addition to pulmonary vein isolation and standard pulmonary vein isolation in patients with paroxysmal atrial fibrillation with the cryoballoon technique.
BACKGROUND
Paroxysmal atrial fibrillation (PAF) can be triggered by non-pulmonary vein foci, like the superior vena cava (SVC). The latter is correlated with improved result in terms of freedom from atrial tachycardias (ATs), when electrical isolation of this vessel utilizing radiofrequency energy (RF) is achieved.
OBJECTIVES
Evaluate the clinical impact, in patients with PAF, of the SVC isolation (SVCi) in addition to ordinary pulmonary vein isolation (PVI) by means of the second-generation cryoballoon (CB) METHODS: A total of 100 consecutive patients that underwent CB ablation for PAF were retrospectively selected. Fifty consecutive patients received PVI followed by SVCi by CB application, and the following 50 consecutive patients received standard PVI. All patients were followed 12 months.
RESULTS
The mean time to SVCi was 36.7 ± 29.0 s and temperature at SVC isolation was - 35 (- 18 to - 40) °C. Real-time recording (RTR) during SVCi was observed in 42 (84.0%) patients. At the end of 12 months of follow-up, freedom from ATs was achieved in 36 (72%) patients in the PVI only group and in 45 (90%) patients of the SVC and PV isolation group (Fisher's exact test p = 0.039, binary logistic regression: p = 0.027, OR = 0.28, 95%CI = 0.09-0.86). In survival analysis, SVC and PV isolation group was also associated with improved freedom from ATs (log-rank test: p = 0.017, Cox regression: p = 0.026, HR = 0.31, 95%CI = 0.11-0.87).
CONCLUSION
Superior vena cava isolation with the CB in addition to PVI might improve freedom from ATs if compared to PVI alone at 1-year follow-up.
Topics: Atrial Fibrillation; Catheter Ablation; Cryosurgery; Humans; Pulmonary Veins; Retrospective Studies; Treatment Outcome; Vena Cava, Superior
PubMed: 33447964
DOI: 10.1007/s10840-020-00932-6 -
The American Journal of Case Reports Mar 2021BACKGROUND Malignant disease is a common etiology of superior vena cava syndrome (SVCS). Being a medical emergency, it often requires rapid diagnostic evaluation and...
BACKGROUND Malignant disease is a common etiology of superior vena cava syndrome (SVCS). Being a medical emergency, it often requires rapid diagnostic evaluation and therapy. Transcaval biopsy and endovascular stenting in a single-setting has been described, but only in a handful of cases. These cases utilized intra-operative venograms. In this study, we also used intra-operative cone beam computed tomography (CBCT) to increase the safety and efficacy of such single-setting procedures. CASE REPORT From January 2017 to July 2019, there were 5 patients with malignant SVCS who underwent single-setting superior vena cava biopsy and endovascular stenting utilizing intra-operative CBCT as an adjunct. Demographic data, clinical presentation, investigation results, procedural details, and patient outcomes were recorded. CBCT was utilized in all cases to optimize sampling of biopsies, visualize subsequent stent positioning, and for early detection of procedure-related complications. Transcaval biopsy was diagnostic in 4 of the 5 patients. Endovascular stents were deployed successfully in all cases, with post-stenting venogram demonstrating relief of prior obstructed segments. One patient had a complication of an apical pneumothorax, with no associated long-term pneumothorax-related morbidity or mortality. CONCLUSIONS This study demonstrates that single-setting transcaval biopsy and stenting in the context of malignant SVCS is a cost-efficient, safe, and feasible approach. In addition, the additional use of intra-operative CBCT is a useful tool to increase procedure efficacy and safety.
Topics: Biopsy; Cone-Beam Computed Tomography; Humans; Stents; Superior Vena Cava Syndrome; Treatment Outcome; Vena Cava, Superior
PubMed: 33750755
DOI: 10.12659/AJCR.929048 -
The Journal of International Medical... Sep 2022Persistent left superior vena cava (PLSVC) is a common venous variation that is usually accompanied by an absence of the left brachiocephalic vein, and displays a higher...
Persistent left superior vena cava (PLSVC) is a common venous variation that is usually accompanied by an absence of the left brachiocephalic vein, and displays a higher incidence in patients with congenital heart disease. Here, the case of a 57-year-old male patient who was found to have PLSVC on chest computed tomography (CT) during screening for gastric cancer metastasis at the Affiliated Hospital of Qinghai University, is described. Further coronal CT and three-dimensional reconstruction of the chest revealed the patient's double superior vena cava (DSVC), double odd veins, and left brachiocephalic vein dysplasia. The patient did not have congenital heart disease and the case was associated with dysplasia of the left brachiocephalic vein, indicating an unusual and rare venous abnormality. At the time of writing, the patient was receiving antitumour therapy.
Topics: Brachiocephalic Veins; Heart Defects, Congenital; Humans; Male; Middle Aged; Persistent Left Superior Vena Cava; Thorax; Vena Cava, Superior
PubMed: 36071611
DOI: 10.1177/03000605221119655 -
Interactive Cardiovascular and Thoracic... Feb 2022To report our experience on the management of superior vena cava graft infection.
OBJECTIVES
To report our experience on the management of superior vena cava graft infection.
METHODS
Between 2001 and 2018, patients with superior vena cava synthetic graft or patch reconstruction after resection of intrathoracic tumours or benign disease were selected retrospectively from the French EPITHOR database and participating thoracic centres. Our study population includes patients with superior vena cava graft infection, defined according to the MAGIC consensus. Superior vena cava synthetic grafts in an empyema or mediastinitis were considered as infected.
RESULTS
Of 111 eligible patients, superior vena cava graft infection occurred in 12 (11.9%) patients with a polytetrafluoroethylene graft secondary to contiguous contamination. Management consisted of either conservative treatment with chest tube drainage and antibiotics (n = 3) or a surgical graft-sparing strategy (n = 9). Recurrence of infection appears in 6 patients. Graft removal was performed in 2 patients among the 5 reoperated patients. The operative mortality rate was 25%.
CONCLUSIONS
Superior vena cava graft infection may develop as a surgical site infection secondary to early mediastinitis or empyema. Graft removal is not always mandatory but should be considered in late or recurrent graft infection or in infections caused by aggressive microorganisms (virulent or multidrug resistant bacteria or fungi).
Topics: Humans; Retrospective Studies; Superior Vena Cava Syndrome; Thoracic Surgery; Vascular Patency; Vena Cava, Superior
PubMed: 34871387
DOI: 10.1093/icvts/ivab337 -
Journal of the American College of... Nov 1987Pulsed wave Doppler ultrasound recordings of blood flow velocity in the superior vena cava were made in 40 healthy adults (aged 22 to 69 years) during both normal...
Pulsed wave Doppler ultrasound recordings of blood flow velocity in the superior vena cava were made in 40 healthy adults (aged 22 to 69 years) during both normal respiration and 10 second episodes of apnea. The forward flow velocity pattern was biphasic, with systolic flow velocity greater than diastolic flow velocity. During apnea, peak flow velocities ranged from 32 to 69 cm/s (mean 45.7 +/- 8.4) during systole and from 6 to 45 cm/s (mean 27.2 +/- 8.3) in early diastole. Systolic flow velocity integrals also exceeded diastolic values. With atrial systole (A wave), forward flow velocities were reduced or flow was reversed. Thirty-nine of 40 subjects had A wave flow reversal during apnea, and in these the ratio of reverse to total forward flow velocity integrals ranged from 1 to 16% (mean 6 +/- 4%). Compared with values during apnea, there were higher mean values with inspiration and lower values with expiration for velocities and flow velocity integrals. Hepatic vein tracings, when adequate (12 of 40 subjects), showed forward flow characteristics similar to those from the superior vena cava, but with more frequent and larger A wave and ventricular end-systole (atrial V wave) flow reversals. Superior vena cava flow velocity variables were calculated in subgroups to assess the effects of age, respiratory pattern and increased venous return. This study defines normal Doppler ultrasound superior vena cava and hepatic vein flow velocities and their variation with respiration in healthy adults. These results can be used for comparison with patterns found in disease states.
Topics: Adult; Age Factors; Aged; Blood Flow Velocity; Echocardiography; Heart Rate; Hepatic Veins; Humans; Middle Aged; Myocardial Contraction; Respiration; Vena Cava, Superior
PubMed: 3668102
DOI: 10.1016/s0735-1097(87)80343-1 -
BMC Pregnancy and Childbirth Feb 2021Fetal superior vena cava (SVC) is essentially the single vessel returning blood from the upper body to the heart. With approximately 80-85% of SVC blood flow...
BACKGROUND
Fetal superior vena cava (SVC) is essentially the single vessel returning blood from the upper body to the heart. With approximately 80-85% of SVC blood flow representing cerebral venous return, its interrogation may provide clinically relevant information about fetal brain circulation. However, normal reference values for fetal SVC Doppler velocities and pulsatility index are lacking. Our aim was to establish longitudinal reference intervals for blood flow velocities and pulsatility index of the SVC during the second half of pregnancy.
METHODS
This was a prospective study of low-risk singleton pregnancies. Serial Doppler examinations were performed approximately every 4 weeks to obtain fetal SVC blood velocity waveforms during 20-41 weeks. Peak systolic (S) velocity, diastolic (D) velocity, time-averaged maximum velocity (TAMxV), time-averaged intensity-weighted mean velocity (TAMeanV), and end-diastolic velocity during atrial contraction (A-velocity) were measured. Pulsatility index for vein (PIV) was calculated.
RESULTS
SVC blood flow velocities were successfully recorded in the 134 fetuses yielding 510 sets of observations. The velocities increased significantly with advancing gestation: mean S-velocity increased from 24.0 to 39.8 cm/s, D-velocity from 13.0 to 19.0 cm/s, and A-velocity from 4.8 to 7.1 cm/s. Mean TAMxV increased from 12.7 to 23.1 cm/s, and TAMeanV from 6.9 to 11.2 cm/s. The PIV remained stable at 1.5 throughout the second half of pregnancy.
CONCLUSIONS
Longitudinal reference intervals of SVC blood flow velocities and PIV were established for the second half of pregnancy. The SVC velocities increased with advancing gestation, while the PIV remained stable from 20 weeks to term.
Topics: Blood Flow Velocity; Female; Fetal Heart; Humans; Pregnancy; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prospective Studies; Reference Values; Regional Blood Flow; Ultrasonography, Doppler; Ultrasonography, Prenatal; Vena Cava, Superior
PubMed: 33622280
DOI: 10.1186/s12884-021-03635-6 -
Interactive Cardiovascular and Thoracic... Oct 2021Epitheloid haemangiothelioma is extremely rare malignant tumour of vascular origin. Mediastinal location of this neoplasm with large veins involving is not common. We...
Epitheloid haemangiothelioma is extremely rare malignant tumour of vascular origin. Mediastinal location of this neoplasm with large veins involving is not common. We report a case of epitheloid haemangiothelioma in superior vena cava treated by radical resection and superior vena cava replacement with polytetrafluoroethylene prosthetic graft. There is a certain risk of neurological injury during the cross-clamping of superior vena cava in patient with incompletely obstructed veins. Venovenous shunt is a useful surgical strategy in this type of lesion without necessity of cardiopulmonary bypass use.
Topics: Adult; Blood Vessel Prosthesis Implantation; Child; Hemangioendothelioma, Epithelioid; Humans; Polytetrafluoroethylene; Sarcoma; Vena Cava, Superior
PubMed: 33948629
DOI: 10.1093/icvts/ivab136 -
Nagoya Journal of Medical Science Aug 2022Superior vena cava (SVC) syndrome refers to a constellation of symptoms secondary to obstruction of blood flow through the SVC. In this condition, venous blood that...
Superior vena cava (SVC) syndrome refers to a constellation of symptoms secondary to obstruction of blood flow through the SVC. In this condition, venous blood that usually drains into the SVC is diverted into the inferior vena cava (IVC) via collateral veins. Reconstructive surgery is challenging in such cases owing to the anomalous venous system. In this case report, we describe reconstructive surgery using a pedicled omental flap in a patient with upper thoracic empyema and concomitant SVC syndrome. A 68-year-old man underwent resection of malignant thymoma, the bilateral brachiocephalic veins, and a part of the right upper lobe, followed by polytetrafluoroethylene (PTFE) graft placement for venous system reconstruction, 2 years prior to presentation. He developed postoperative upper thoracic cavity empyema, which necessitated PTFE graft removal. Although the infection was controlled after 2 months, multiple right upper lobe pulmonary fistulas persisted, and the patient was referred to our department for further evaluation. Contrast-enhanced computed tomography revealed SVC syndrome characterized by SVC obstruction and consequent drainage of venous blood from the upper trunk into the IVC via collateral vessels. We debrided necrotic and infected tissues, and a pedicled omental flap was placed for upper lobe fistula coverage. The patient showed an uncomplicated postoperative course, and no recurrent empyema or pulmonary fistulas were observed 3 years postoperatively. Flaps associated with the SVC system show high venous pressures. The use of a pedicled omental flap was deemed feasible because this graft reaches the upper thorax even though it is associated with the IVC system.
Topics: Aged; Empyema, Pleural; Humans; Male; Polytetrafluoroethylene; Plastic Surgery Procedures; Superior Vena Cava Syndrome; Vena Cava, Superior
PubMed: 36237890
DOI: 10.18999/nagjms.84.3.648 -
Heart Rhythm Jul 2022Transvenous pacemaker and defibrillator lead extraction is a higher risk procedure with variation in preferred technique. A frequently fatal complication of this...
BACKGROUND
Transvenous pacemaker and defibrillator lead extraction is a higher risk procedure with variation in preferred technique. A frequently fatal complication of this procedure is perforation of the superior vena cava. We have developed a tandem femoral-superior technique that incorporates snaring of targeted leads from a femoral approach combined with use of a rotational cutting sheath advanced over the lead from the subclavian vein.
OBJECTIVE
We sought to evaluate the safety and efficacy of a tandem femoral-superior approach to lead extraction.
METHODS
Consecutive patients undergoing transvenous extraction of at least 1 pacemaker or defibrillator lead with implant duration ≥1 year in which a tandem femoral-superior technique was used as the initial extraction strategy were included. The registry spanned 2010-2018 and consisted of procedures performed by a single primary operator.
RESULTS
A total of 131 patients were included. A total of 267 leads with a mean implant duration of 9.8 years, including 90 defibrillator leads (33.7%), were targeted for extraction. No superior vena cava perforation or other vascular damage occurred. Clinical procedural success was achieved in 96.2% of cases. There were 5 major complications (3.8% of patients), with 3 being pericardial effusion requiring intervention. There were no deaths.
CONCLUSION
A tandem femoral-superior approach to lead extraction effectively eliminated superior vena cava injury. This is a safe and effective technique for transvenous lead extraction.
Topics: Defibrillators, Implantable; Device Removal; Humans; Pacemaker, Artificial; Retrospective Studies; Thoracic Injuries; Treatment Outcome; Vena Cava, Superior
PubMed: 35245690
DOI: 10.1016/j.hrthm.2022.02.024 -
The Journal of Thoracic and... Dec 2020In this study we sought to determine whether preoperative superior vena cava (SVC) blood flow measured using cardiac magnetic resonance (CMR) predicts physiology and...
BACKGROUND
In this study we sought to determine whether preoperative superior vena cava (SVC) blood flow measured using cardiac magnetic resonance (CMR) predicts physiology and clinical outcome after bidirectional cavopulmonary shunt (BCPS).
METHODS
The retrospective single-center study included 65 (2012-2017) patients who underwent BCPS. Preoperative CMR imaging, echocardiography, catheterization, and clinical outcomes were reviewed. SVC flow was measured using phase contrast CMR. The Kaplan-Meier method and Cox regression was used for BCPS takedown-free survival and predictor analyses.
RESULTS
The absolute and indexed SVC flow was 0.5 (interquartile range [IQR], 0.4-0.7) L/min and 1.7 (IQR, 1.4-2.0) L/min/mm respectively, which was comparable with the SVC blood flow volume previously measured. The median age and body weight at BCPS was 6.5 (IQR, 5.5-8.5) months and 6.9 (IQR, 6.0-7.7) kg. After follow-up, at a median of 17.1 (IQR, 7.9-41.3) months, 14 patients (21.5%) underwent the Fontan completion and 40 (61.5%) with BCPS physiology were waiting for the Fontan completion. The 11 remaining patients (16.9%), included those who underwent takedown (n = 7; 10.8%) or died with a BCPS (n = 4; 6.2%). Severe hypoxia was the leading cause of mortality, directly accounting for two-thirds of deaths (66.6%; 6/9). The BCPS takedown-free survival was 96.8% at 6 months, and 79.9% at 3 years. Preoperative SVC blood flow was significantly positively correlated with early post-BCPS arterial saturation (P = .00). The multivariable analysis showed SVC flow was the only factor associated with BCPS failure (hazard ratio, 0.186; P = .04) among the predictors related to the pre-BCPS anatomy and physiology.
CONCLUSIONS
SVC blood flow might be as critically important as pulmonary artery anatomic and physiologic parameters in the evaluation of BCPS candidacy in the single-ventricle population.
Topics: Blood Flow Velocity; Echocardiography; Female; Follow-Up Studies; Fontan Procedure; Heart Defects, Congenital; Humans; Infant; Male; Predictive Value of Tests; Retrospective Studies; Treatment Failure; Vena Cava, Superior
PubMed: 32595030
DOI: 10.1016/j.jtcvs.2020.04.098