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Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement

BACKGROUND: Persistent left superior vena cava (LSVC) with connection to the left atrium (LA) is a rare anomaly with serious clinical implications. Depending on the direction of flow through the intracardiac shunt, clinical presentation varies from cyanosis or paradoxical embolism to overt right hea...

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Autores principales: Duong, Phuoc, Papaioannou, Vasileios, Moharam-Elgamal, Sarah, Kang, Sok-Leng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549595/
https://www.ncbi.nlm.nih.gov/pubmed/36225811
http://dx.doi.org/10.1093/ehjcr/ytac382
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author Duong, Phuoc
Papaioannou, Vasileios
Moharam-Elgamal, Sarah
Kang, Sok-Leng
author_facet Duong, Phuoc
Papaioannou, Vasileios
Moharam-Elgamal, Sarah
Kang, Sok-Leng
author_sort Duong, Phuoc
collection PubMed
description BACKGROUND: Persistent left superior vena cava (LSVC) with connection to the left atrium (LA) is a rare anomaly with serious clinical implications. Depending on the direction of flow through the intracardiac shunt, clinical presentation varies from cyanosis or paradoxical embolism to overt right heart failure. CASE SUMMARY: A 26-year-old man with repaired ventricular septal defect (VSD) during infancy presented with symptoms of progressive exercise intolerance. Cardiac imaging revealed a large defect at the posterior wall of the LSVC above its entry to the coronary sinus (CS), connecting the LSVC with the LA and resulting in diversion of pulmonary venous return to the CS. All pulmonary veins connect normally to the LA. The large left-to-right intracardiac shunt led to significant right ventricular dilation and tricuspid regurgitation. He underwent successful anatomical repair with transcatheter implantation of covered stent from LSVC to the CS, redirecting pulmonary venous return to the LA. At 1 year follow up, his exercise capacity had improved, and cardiac imaging showed complete seal of the LSVC defect without obstruction to pulmonary venous return. DISCUSSION: Our case is the first to our knowledge to report this unusual anatomic variant of LSVC to LA connection, and complete repair by transcatheter treatment. Previous case reports of other forms of LSVC to LA connection were treated with surgery or device occlusion without reconnection of LSVC. This case highlights the efficacy and safety of innovative percutaneous techniques in the management of complex congenital heart lesions. Meticulous procedural planning through 3D modelling and simulation is vital to mitigate the risks of these innovative procedures.
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spelling pubmed-95495952022-10-11 Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement Duong, Phuoc Papaioannou, Vasileios Moharam-Elgamal, Sarah Kang, Sok-Leng Eur Heart J Case Rep Case Report BACKGROUND: Persistent left superior vena cava (LSVC) with connection to the left atrium (LA) is a rare anomaly with serious clinical implications. Depending on the direction of flow through the intracardiac shunt, clinical presentation varies from cyanosis or paradoxical embolism to overt right heart failure. CASE SUMMARY: A 26-year-old man with repaired ventricular septal defect (VSD) during infancy presented with symptoms of progressive exercise intolerance. Cardiac imaging revealed a large defect at the posterior wall of the LSVC above its entry to the coronary sinus (CS), connecting the LSVC with the LA and resulting in diversion of pulmonary venous return to the CS. All pulmonary veins connect normally to the LA. The large left-to-right intracardiac shunt led to significant right ventricular dilation and tricuspid regurgitation. He underwent successful anatomical repair with transcatheter implantation of covered stent from LSVC to the CS, redirecting pulmonary venous return to the LA. At 1 year follow up, his exercise capacity had improved, and cardiac imaging showed complete seal of the LSVC defect without obstruction to pulmonary venous return. DISCUSSION: Our case is the first to our knowledge to report this unusual anatomic variant of LSVC to LA connection, and complete repair by transcatheter treatment. Previous case reports of other forms of LSVC to LA connection were treated with surgery or device occlusion without reconnection of LSVC. This case highlights the efficacy and safety of innovative percutaneous techniques in the management of complex congenital heart lesions. Meticulous procedural planning through 3D modelling and simulation is vital to mitigate the risks of these innovative procedures. Oxford University Press 2022-10-03 /pmc/articles/PMC9549595/ /pubmed/36225811 http://dx.doi.org/10.1093/ehjcr/ytac382 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Case Report
Duong, Phuoc
Papaioannou, Vasileios
Moharam-Elgamal, Sarah
Kang, Sok-Leng
Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement
title Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement
title_full Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement
title_fullStr Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement
title_full_unstemmed Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement
title_short Case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement
title_sort case report of a left superior vena cava to left atrial connection treated with percutaneous covered stent placement
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549595/
https://www.ncbi.nlm.nih.gov/pubmed/36225811
http://dx.doi.org/10.1093/ehjcr/ytac382
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