J Cardiovasc Ultrasound.  2013 Mar;21(1):33-36. 10.4250/jcu.2013.21.1.33.

Transcatheter Treatment of Patent Foramen Ovale Combined with Abnormal Drainage of Left Superior Vena Cava to Left Upper Pulmonary Vein

• Kim DH
• Park SJ
• Jung JW
• Kim NK
• Choi JY

• KMID: 1428376
• DOI: http://doi.org/10.4250/jcu.2013.21.1.33

Abstract

Patent foramen ovale (PFO) has been known to be the cause of transient ischemic attacks or stroke, and transcatheter device closure has been the treatment of choice for these defects. Combined defect of abnormal drainage of left superior vena cava (LSVC) to left superior pulmonary vein (LSPV) in PFO patients is an uncommon combination, and both can act as a pathway for paradoxical embolism. We report a successful closure of PFO, using Amplatzer(R) PFO occluder (St. Jude Medical, St. Paul, MN, USA) and persistent LSVC connected to LSPV using an Amplatzer(R) Vascular Plug II (St. Jude Medical, St. Paul, MN, USA). Because this combined anomaly of PFO and persistent LSVC can be treated by a single transcatheter intervention, if clinically suspected, a complete evaluation for this anomaly should be considered.

Keyword

Patent foramen ovale; Persistent left superior vena cava; Transcatheter; Occluder; Vascular plug; Amplatzer(R)

MeSH Terms

Drainage
Embolism, Paradoxical
Foramen Ovale, Patent
Humans
Ischemic Attack, Transient
Pulmonary Veins
Stroke
Vena Cava, Superior

Figure

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  Fig. 1 Agitation saline injection test. On contrast echo conducted on Rt. arm, the enhancement was seen at not only Rt. side of heart, but also Lt. side. Sequential filling of the bubble in the left atrium followed by left ventricle and then through the patent foramen ovale to the right atrium. On Lt. arm contrast echocardiography, massive amount of microbubbles draining straight to LA was detected. LA: left atrium, LV: left ventricle, RA: right atrium, RV: right ventricle.

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  Fig. 2 Abnormal Drainage of LSVC to LUPV are shown on three dimensional computed tomography. LSVC: left superior vena cava, LUPV: left upper pulmonary vein, RSVC: right superior vena cava.

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  Fig. 3 Angiogram. Abnormal connection of LSVC to left atrium was shown on angiogram. LSVC: left superior vena cava, LUPV: left upper pulmonary vein.

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  Fig. 4 Abnormal drainage of left superior vena cava and left upper pulmonary vein was closed using the Amplatzer® vascular plug II.

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  Fig. 5 Transcatheter PFO closure with Amplatzer® PFO occluder. PFO: patent foramen ovale.

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