Author + information
- Received May 1, 2015
- Accepted June 19, 2015
- Published online November 1, 2015.
- Andrew R. Leventhal, MD, PhD∗,
- Ashish H. Shah, MD, MD-Research∗,
- Andrew M. Crean, MD∗,
- Mark Osten, MD∗,
- Eric Horlick, MD∗ and
- Lee Benson, MD†∗ ()
- ∗Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- †The Hospital for Sick Children, Toronto, Ontario, Canada
- ↵∗Reprint requests and correspondence:
Dr. Lee Benson, The Hospital for Sick Children, 6-246, EN, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
A 69-year-old woman presented with dyspnea and oxygen saturation of 89%. Echocardiogram showed a dilated coronary sinus. When injected in the right arm (but not the left), bubbles appeared in the left atrium (LA). Computed tomography showed bilateral superior vena cavae (SVC) connected by a bridging vein. The left SVC drained to the coronary sinus. The right SVC drained to the right upper pulmonary vein (RUPV) and into the LA. A smaller caliber remnant of the right SVC connected the RUPV to the right atrium. It appeared as though the right SVC was transected by the RUPV (Figures 1A and 1B).
Angiography confirmed the connections (Figure 1C). Balloon occlusion of the lower right SVC did not alter pressure in the upper right SVC. A 14-mm Amplatzer Vascular Plug II (St. Jude Medical, St. Paul, Minnesota) was deployed in the right SVC at the SVC-RUPV junction. A 10-mm Amplatzer Vascular Plug II was deployed in the inferior remnant of the right SVC at the SVC-RUPV junction. Completion angiography from the right pulmonary artery showed unobstructed flow from the RUPV to the left atrium (Figure 1D). Femoral artery oxygen saturation rose from 90% to 94%.
The most common systemic venous anomaly is a persistent left-sided SVC (0.3%) (1). Percutaneous closure of a left SVC draining to the LA (2) and surgical correction of a right SVC draining to the LA (3) have been described. To our knowledge, this is the first report describing percutaneous closure of a right SVC to LA connection.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 1, 2015.
- Accepted June 19, 2015.
- American College of Cardiology Foundation