Reopening of persistent left superior caval vein after bidirectional cavopulmonary connections

Persistent left superior vena cava (SVC) is a not uncommon finding in patients with congenital heart disease. This anatomical variant must be recognised before doing a Glenn anastomosis, bidirectional cavopulmonary connection or a Fontan-type procedure. Following these procedures, reopening of a lef...

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Bibliographic Details
Published in:Heart (British Cardiac Society) 1998-05, Vol.79 (5), p.509-512
Main Authors: Filippini, L H P M, Ovaert, C, Nykanen, D G, Freedom, R M
Format: Article
Language:English
Subjects:
Age
Biological and medical sciences
Cardiac catheterization
Cardiology. Vascular system
Case Studies
cavopulmonary connection
Child, Preschool
Collateral Circulation
congenital heart disease
Congenital heart diseases. Malformations of the aorta, pulmonary vessels and vena cava
Cyanosis
Cyanosis - diagnostic imaging
Cyanosis - etiology
Fontan Procedure
Heart
Heart Bypass, Right
Humans
Medical imaging
Medical sciences
persistent left superior vena cava
Postoperative Complications - diagnosis
Postoperative Complications - surgery
Pulmonary arteries
Radiography
Veins & arteries
Vena Cava, Superior - abnormalities
Vena Cava, Superior - diagnostic imaging
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Summary:Persistent left superior vena cava (SVC) is a not uncommon finding in patients with congenital heart disease. This anatomical variant must be recognised before doing a Glenn anastomosis, bidirectional cavopulmonary connection or a Fontan-type procedure. Following these procedures, reopening of a left SVC leading to clinical cyanosis can occur. Five cases are described in whom persisting left SVCs were excluded before performing a bidirectional cavopulmonary connection or Fontan procedure but (re-)opened after surgery, leading to cyanosis either by reducing effective pulmonary blood flow (bidirectional cavopulmonary connection) or by an obligatory right to left shunt (Fontan). These observations suggest that, embryologically, the lumen of the left SVC obliterates rather than disappears. Balloon occlusion angiography of the innominate vein before cavopulmonary connections or Fontan procedures might improve detection of these collateral vessels.
ISSN:1355-6037
1468-201X
DOI:10.1136/hrt.79.5.509