J Cardiovasc Ultrasound.  2012 Mar;20(1):49-51. 10.4250/jcu.2012.20.1.49.

Role of Echocardiography in Sinus Venosus Atrial Septal Defect Combined with Systemic and Pulmonary Vascular Disease

• Ahn J
• Park SH
• Kim D
• Kim T
• Jo S
• Lee H
• Cho A

• KMID: 2177341
• DOI: http://doi.org/10.4250/jcu.2012.20.1.49

Abstract

We present a case of persistent left superior vena cava, anomalous right pulmonary venous connection to the right-sided superior vena cava and sinus venosus atrial septal defect detected by computed tomography (CT) pulmonary angiography and echocardiography. These defects were surgically corrected using a double-patch technique. In fact, CT can provide anatomical information about a complex anomaly in the systemic and pulmonary vasculatures. Though modern imaging techniques are useful for detecting complex cardiovascular disease, careful echocardiographic examination should be performed to diagnose complex cardiac anomalies.

Keyword

Atrial septal defect; Pulmonary veins/abnormalities; Computed tomography

MeSH Terms

Angiography
Cardiovascular Diseases
Echocardiography
Heart Septal Defects, Atrial
Vascular Diseases
Vena Cava, Superior

Figure

• 

  Fig. 1 Echocardiographic findings in the patient. A: Modified apical 4-chamber view showing markedly dilated right-sided heart chambers and coronary sinus (arrow). B: Transesophageal echocardiography demonstrating sinus venosus atrial septal defect. C: Normal opacification of the right side of the heart following an agitated saline injection through a right brachial vein. D: Early opacification of the abnormally large coronary sinus (arrow) following an agitated saline injection through a left brachial vein. RA: right atrium, SVC: superior vena cava.

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  Fig. 2 Computed tomography (CT) appearance of the patient. A: Coronal reconstruction of the CT pulmonary angiogram (CTA-PA) showing the course of the left superior vena cava (SVC) (arrow). B: Cross-sectional CTA-PA displaying the right superior pulmonary vein draining into the right SVC (arrow). C: CTA-PA showing atrial septal defect (arrow). D: Three-dimensional reconstruction of the coronary CT angiogram demonstrating more detailed structural information of the drainage of persistent left superior vena cava (arrow) into the right atrium via a dilated coronary sinus. CS: coronary sinus, RA: right atrium, RV: right ventricle.

Reference

1. Edwards JE, Dushane JW, Alcott DL, Burchell HB. Thoracic venous anomalies. III. Atresia of the common pulmonary vein, the pulmonary veins draining wholly into the superior vena cava. AMA Arch Pathol. 1951. 51:446–460.

2. Goyal SK, Punnam SR, Verma G, Ruberg FL. Persistent left superior vena cava: a case report and review of literature. Cardiovasc Ultrasound. 2008. 6:50.

3. Gonzalez-Juanatey C, Testa A, Vidan J, Izquierdo R, Garcia-Castelo A, Daniel C, Armesto V. Persistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review. Clin Cardiol. 2004. 27:515–518.

4. Haramati LB, Moche IE, Rivera VT, Patel PV, Heyneman L, McAdams HP, Issenberg HJ, White CS. Computed tomography of partial anomalous pulmonary venous connection in adults. J Comput Assist Tomogr. 2003. 27:743–749.

5. Weiman DS, Lee K, Levett JM, Replogle RL. Partial anomalous pulmonary venous return: a ten-year experience. Tex Heart Inst J. 1985. 12:239–243.

6. Ammash NM, Seward JB, Warnes CA, Connolly HM, O'Leary PW, Danielson GK. Partial anomalous pulmonary venous connection: diagnosis by transesophageal echocardiography. J Am Coll Cardiol. 1997. 29:1351–1358.

7. Pucelikova T, Kautznerova D, Vedlich D, Tintera J, Kautzner J. A complex anomaly of systemic and pulmonary venous return associated with sinus venosus atrial septal defect. Int J Cardiol. 2007. 115:e47–e48.

8. Benson RE, Songrug T. CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect. Br J Radiol. 2009. 82:e235–e239.