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Intravenous lipomas (IVLs) of the head and neck are uncommon benign tumors that develop within the venous walls, often detected incidentally during imaging for unrelated issues. While usually asymptomatic, these IVLs can cause congestive venous symptoms like swelling, paresthesia or pain in the head and neck and upper limbs, or even venous thromboembolism. The precise diagnosis of IVLs is predominantly achieved through computed tomography (CT) and magnetic resonance imaging (MRI), with CT being the most frequently used method. Symptomatic patients generally undergo open surgery with excision of the IVL followed by venous reconstruction, which has shown safe and effective outcomes. However, the management of asymptomatic IVLs remains controversial due to the limited number of reported cases. Despite this, there is a notable trend toward recommending surgical removal of IVLs to prevent complications and rule out malignancy, driven by the challenges of differentiating IVLs from malignant tumors using imaging alone. This review highlights the key differential imaging characteristics of IVLs and the main surgical techniques to remove the tumor and repair the vascular defect. Further research is necessary to establish a robust, evidence-based approach for treating asymptomatic IVLs, balancing the risks of surgery against the potential for future complications. [ABSTRACT FROM AUTHOR]

Background: Superior vena cava (SVC) is atrial fibrillation (AF)’s most common non-pulmonary vein (PV) foci. Studies reported conflictory results when SVC isolation (SVCi) was combined with PVi and long-term outcomes were lacking. Therefore, we aimed to evaluate the long-term efficacy and safety of empirical SVCi as an adjunct to cryoballoonbased PV isolation (PVi) in persistent AF ablation. Methods: A total of 40 consecutive persistent AF patients (60.6 ± 8.2 years, 52.5% females) who underwent SVCi in addition to PVi compared with a propensity score matched cohort of 40 persistent AF patients (58.6 ± 8.7 years, 50% female) in whom PVionly was performed. Second-generation cryoballoon (CB2) was used in all procedures. Atrial tachyarrhythmia (ATa) recurrence was defined as the detection of AF, atrial flutter, or atrial tachycardia (≥30 s) after a 3-month blanking period. Results: Pulmonary veins and SVC were successfully isolated in all patients. At a mean of 46.7 ± 7.8 months follow-up, 22 (55%) patients in the PVi-only group, and 27 (67.5%) patients in the PVi+SVCi group were free of ATa after the index procedure (P = .359). Phrenic nerve injury (PNI) was detected in 2 (5%) patients in the PVi-only group (during right PVi) and 2 (5%) patients in the PVi+SVCi group (during SVCi) (P = 1.00). Cox regression analysis revealed that early recurrence was the only predictor of recurrence (hazard ratio 4.88, 95% confidence interval 1.59-14.96; P = .005). Conclusion: Long-term results of our small sample-sized study revealed that CB-based PVi+SVCi was associated with outcomes similar to the PVi-only strategy in patients with persistent AF. Although complication rates were similar between the groups, close follow-up of diaphragmatic movement is crucial to prevent PNI during SVCi. [ABSTRACT FROM AUTHOR]

Blood flow in the hepatic veins and superior vena cava (SVC) reflects right heart filling; however, their Doppler profiles are often not identical, and no studies have compared their diagnostic efficacies. We aimed to determine which venous Doppler profile is reliable for detecting elevated right atrial pressure (RAP). In 193 patients with cardiovascular diseases who underwent cardiac catheterization within 2 d of echocardiography, the hepatic vein systolic filling fraction (HV-SFF) and the ratio of the peak systolic to diastolic forward velocities of the SVC (SVC-S/D) were measured. HV-SFF < 55% and SVC-S/D < 1.9 were regarded as elevated RAP. We also calculated the fibrosis 4 index (FIB-4) as a serum liver fibrosis marker. HV-SFF and SVC-S/D were feasible in 177 (92%) and 173 (90%) patients, respectively. In the 161 patients in whom both venous Doppler waveforms could be measured, HV-SFF and SVC-S/D were inversely correlated with RAP (r = −0.350, p < 0.001; r = −0.430, p < 0.001, respectively). SVC-S/D > 1.9 showed a significantly higher diagnostic accuracy of RAP elevation compared with HV-SFF < 55% (area under the curve, 0.842 vs. 0.614, p < 0.001). Multivariate analyses showed that both FIB-4 (β = −0.211, p = 0.013) and mean RAP (β = −0.319, p < 0.001) were independent determinants of HV-SFF. In contrast, not FIB-4 but mean RAP (β = −0.471, p < 0.001) was an independent determinant of SVC-S/D. The diagnostic accuracy remained unchanged when HV-SFF < 55% was considered in conjunction with the estimated RAP based on the inferior vena cava morphology. Conversely, SVC-S/D showed an incremental diagnostic value over the estimated RAP. SVC-S/D enabled a more accurate diagnosis of RAP elevation than HV-SFF. [ABSTRACT FROM AUTHOR]

Introduction: Double vena cava is the most common thoracic abnormality and is mainly caused by persistence of the left superior vena cava and are usually described incidentally after placement of central venous accesses. Objective: Presentation of a clinical case where a double superior vena cava was identified after the placement of a Mahurkar-type catheter. Clinical case: A 54-year-old man was admitted to the nephrology department with a diagnosis of angioaccess-associated infection. Mahurkar catheter was placed without complications, atypical location was observed by chest X-ray, so CT angiography was requested suggestive images of left superior vena cava persistence with a central venous catheter inside are reported. Discussion: The identification of superior double vena cava in most cases occurs incidentally after the placement of a central venous access, after taking a plain chest x-ray where a persistent left superior vena cava can be observed, and it may be accompanied by other abnormalities. Conclusions: Knowing the possible vascular alterations helps prevent complications during procedures such as central venous catheter placement. [ABSTRACT FROM AUTHOR]

(1) Background: The peripherally inserted central catheter (PICC) is commonly used in medicine. The tip position was shown to be a major determinant in PICC function and related complications. Recent advances in ECG guidance might facilitate daily practice. This study aimed to compare two ECG techniques, in terms of their tip-position accuracy, puncture site layout, and signal quality; (2) Methods: This randomized open study (1:1) included 320 participants. One PICC guidance technique used ECG signal transmission with saline (ST); the other technique used a guidewire (WT). Techniques were compared by the distance between the catheter tip and the cavoatrial junction (DCAJ) on chest X-rays, insertion-point hemostasis time, and the extracorporeal catheter length between the hub and the insertion point; (3) Results: The mean DCAJs were significantly different between ST (1.36 cm, 95% CI: 1.22–1.37) and WT (1.12 cm, 95% CI: 0.98–1.25; p = 0.013) groups. When DCAJs were classified as optimal, suboptimal, or inadequate, the difference between techniques had limited clinical impact (p = 0.085). However, the hemostasis time at the puncture site was significantly better with WT (no delay in 82% of patients) compared to ST (no delay in 50% of patients; p < 0.001). Conversely, ST achieved optimal and suboptimal extracorporeal lengths significantly more frequently than WT (100% vs. 66%; p < 0.001); (4) Conclusions: ECG guidance technologies achieved significantly different tip placements, but the difference had minimal clinical impact. Nevertheless, each technique displayed an important drawback at the PICC insertion point: the extracorporeal catheter was significantly longer with WT and the hemostasis delay was significantly longer with ST. [ABSTRACT FROM AUTHOR]

Transcatheter sinus venosus defect (SVD) closure with covered stents is emerging as an alternative to surgery. An adequate anchor zone in the superior vena cava is mandatory for the stability of the covered stent to prevent caudal embolization. There is a potential risk of innominate vein occlusion by the fabric of the covered stent in patients with a very short superior caval vein. Three among a total of 105 patients who underwent SVD closure at our institution developed innominate vein occlusion. Predisposing anatomical factors, identification and management of occluded innominate vein, and follow-up outcomes are discussed. [ABSTRACT FROM AUTHOR]

Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes. Since patients with pretricuspid shunts are often clinically asymptomatic, correction is primarily performed to prevent a persistent right heart volume overload and allow remodeling of the heart chambers. Any residual left-to-right shunt after a correction will result in persistent right heart dilatation. Residual flows can result from various mechanisms, including lack of apposition of the covered stent to the free edge of the SVD, fabric breach, and persistent anomalous drainage of additional right-sided pulmonary veins that drain very high in the SVC or can be due to a coexistent defect in the oval fossa. This review analyzes the different mechanisms, explains the transesophageal and angiographic images for each one, and offers solutions tailored for various reasons. Different mechanisms warrant different treatment principles. A solution for residual shunt from one mechanism may not be appropriate for residual flow through another mechanism. A thorough understanding would aid the operator in effective interventions for these SVDs. [ABSTRACT FROM AUTHOR]

The azygos venous system is a crucial conduit of the posterior thorax and potentially vital collateral pathway. However, it is often overlooked clinically and radiologically. This pictorial essay reviews the normal azygos venous anatomy and CT findings of congenital variations and structural changes associated with acquired pathologies. [ABSTRACT FROM AUTHOR]

Background: Radiofrequency (RF) catheter ablation of para‐Hisian accessory pathways (APs) can be challenging due to proximity to the conduction system. Methods: A total of 30 consecutive patients with para‐Hisian AP were enrolled for ablation in three centers, 12 (40%) of whom had previously failed attempted ablation from the inferior vena cava (IVC) approach. Ablation was preferentially performed using a superior approach from the superior vena cava (SVC) in all patients. Results: The para‐Hisian AP was eliminated from the SVC approach in 28 of 30 (93.3%) patients. In the remaining two patients, additional ablation from IVC was required to successfully eliminate the AP. There were two patients experienced reversible complete atrial‐ventricular block and PR prolongation during the first RF application. Long‐term freedom from recurrent arrhythmia was achieved in 29 (96.7%) patients over a mean follow‐up duration of 15.6 ± 4.6 months. Conclusion: Catheter ablation of para‐Hisian AP from above using a direct SVC approach is both safe and effective, and should be considered especially in patients who have failed conventional ablation attempts from IVC approach. [ABSTRACT FROM AUTHOR]

We report a case of atrial fibrillation (AF) recurrence after pulmonary vein isolation, which patient had AF trigger in the superior vena cava (SVC) near the sinus node (SN). The ultra‐high‐resolution mapping revealed that SN located within the SVC and the atrial activation from the SN to SVC propagated in both septal and lateral direction, then upward with circumventing the spontaneous conduction block identified just above and lateral SN (upper hemisphere). We successfully isolated SVC including the ectopic origin at the same level as the SN by utilizing the spontaneous conduction block line around the SN without any complication. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the optimal range of quantitative ablation index (AI) value during superior vena cava (SVC) electrical isolation by radiofrequency catheter ablation (RFCA). Methods: First, in a development cohort of patients with atrial fibrillation (AF), the RFCA with 40 W was performed to complete SVC isolation guided by the conduction breakthrough point from the right atrium to SVC. Then, the range of AI value was calculated by offline analysis on different segments of SVC. Lastly, for the validation of AF patients, the safety and effectiveness of SVC isolation with the optimized target range of AI value were evaluated with an additional adenosine test. Results: A total of 101 patients with AF were included in the study (44 patients in the development cohort/57 in the validation cohort). The segmental ablation strategy was applied in 70% of the patients. According to the offline analysis of the AI values in the development cohort, the target AI value range was set as 350–400. The success rate of SVC isolation in the validation cohort was significantly higher than that in the exploration cohort (100% vs. 90.9%, p =.02), and no complications occurred in the exploration cohort. During the adenosine test, the recovery rate of electrical conduction in SVC was significantly lower than that in the pulmonary vein (3.5% vs. 17.5%). Conclusion: The target AI value with a range from 350 to 400 is safe and effective for high‐power RFCA to complete SVC isolation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the effectiveness of palliative radiation therapy (RT) for superior vena cava (SVC) syndrome from lung cancer and to compare the 2-week and 1-week schedules. Materials and Methods: A retrospective study was conducted on lung cancer patients with palliative RT for SVC syndrome. Patients received 30 Gy in 10 fractions (2-week group) or 20 Gy in 5 fractions (1-week group) between July 2012 and June 2022. Treatment outcomes were evaluated at 1 to 2 months after RT. The tumor response and recanalization were evaluated based on the computed tomography (CT). Results: Of the 39 patients, 24 received a 2-week course RT and 15 received a 1-week course of RT. The most common SVC-associated symptoms were edema (51.3%) and dyspnea (43.6%). There were no significant differences in performance status, histology, and grade of SVC. Symptom relief in symptomatic patients was comparable (85.7% in the 2-week group vs. 91.6% in the 1-week group; p = 0.581). There were no significant differences between the 2-week and 1-week groups in recanalization rates (62.5% vs. 60.0%; p = 0.876), tumor responses (75% vs. 60.0%; p = 0.876), and 6-month overall survival rates (29.2% vs. 36.4%; p = 0.726). In each of the two groups, one patient was consulted for re-irradiation. The median survival were 3.7 months for the 2-week group and 4.4 months for the 1-week group. Conclusion: In patients with SVC syndrome, the palliative effect of a 1-week course was equivalent to that of a 2-week course. Given the poor prognosis, a 1-week course may be an option. [ABSTRACT FROM AUTHOR]

Background: Identification of normal variations to the thoracic central venous system anatomy is essential in radiological intervention and cardiothoracic surgery to prevent complications. Purpose: To estimate the prevalence and pattern of normal variations of superior vena cava (SVC) and azygos venous system as well as factors associated with normal variations of SVC. Material and Methods: Venous-phase chest CT of 1336 patients were retrospectively reviewed. Age, sex, and underlying disease were recorded. SVC diameter and cross-sectional area were measured to evaluate for associations with normal variations. Results: The prevalence of normal anatomical variations of SVC and azygos venous system were 0.3% and 1.5%, respectively. Duplicated SVC was the most common variations. The most common variation for the azygos venous system was the connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein (12/1336 cases, 0.9%). The median (interquartile range [IQR]) cross-sectional area compared between normal SVC (297.2 mm2) and duplicated SVC (223.5 mm2) showed a statistically significant difference (P = 0.033). Conclusion: This study determined the prevalence of rare normal variations of the azygos venous system, a connection between the hemiazygos and accessory hemiazygos veins draining into the left brachiocephalic vein. The prevalence of normal variations of the SVC and azygos venous system in the adult Thai population was similar with that of previous publications. Cross-sectional area was the only factor with a significant association with SVC variations. [ABSTRACT FROM AUTHOR]

Introduction: Umbilical cord milking (UCM) is a method that allows for postnatal placental transfusion. The benefits of UCM have been demonstrated in some studies, but knowledge about its haemodynamic effects in term infants is limited. The aim of this study was to evaluate the haemodynamic effects of UCM in term infants. Methods: In this prospective, randomised controlled study, 149 healthy term infants with a birth week of ≥37 weeks were randomly assigned to either the UCM or immediate cord clamping (ICC) group. Blinded echocardiographic evaluations were performed in all the neonates in the first 2--6 h. Results: Superior vena cava (SVC) flow measurements were higher in the UCM group compared to the ICC group (132.47 ± 37.0 vs. 126.62 ± 34.3 mL/kg/min), but this difference was not statistically significant. Left atrial diameter (12.23 ± 1.99 vs. 11.43 ± 1.78 mm) and left atrium-to-aorta diastolic diameter ratio (1.62 ± 0.24 vs. 1.51 ± 0.22) were significantly higher in the UCM group. There were no significant differences in other echocardiographic parameters between the two groups. Conclusıon: We found no significant difference in the SVC flow measurements in term infants who underwent UCM versus those who underwent ICC. This lack of significant difference in SVC flow may be explained by the mature cerebral autoregulation mechanism in term neonates. [ABSTRACT FROM AUTHOR]

Objectives: Upright computed tomography (CT) can detect slight changes particularly in the superior vena cava (SVC) volume in healthy volunteers under the influence of gravity. This study aimed to evaluate whether upright CT-based measurements of the SVC area are useful for assessing mean right atrial pressure (mRAP) in patients with heart failure. Methods: We performed CT in both standing and supine positions to evaluate the SVC (directly below the junction of the bilateral brachiocephalic veins) and inferior vena cava (IVC; at the height of the diaphragm) areas and analyzed their relationship with mRAP, measured by right heart catheterization in 23 patients with heart failure. Results: The median age of enrolled patients was 60 (51−72) years, and 69.6% were male. The median mRAP was 3 (1−7) mmHg. The correlations between the standing position SVC and IVC areas and mRAP were stronger than those in the supine position (SVC, ρ = 0.68, p < 0.001 and ρ = 0.43, p = 0.040; IVC, ρ = 0.57, p = 0.005 and ρ = 0.46, p = 0.026; respectively). Furthermore, the SVC area in the standing position was most accurate in identifying patients with higher mRAP (> 5 mmHg) (SVC standing, area under the receiver operating characteristic curve [AUC] = 0.91, 95% confidence interval [CI], 0.77–1.00; SVC supine, AUC = 0.78, 95% CI, 0.59–0.98; IVC standing, AUC = 0.77, 95% CI, 0.55–0.98; IVC supine, AUC = 0.72, 95% CI, 0.49–0.94). The inter- and intraobserver agreements (evaluated by intraclass correlation coefficients) for all CT measurements were 0.962–0.991. Conclusions: Upright CT-based measurement of the SVC area can be useful for non-invasive estimation of mRAP under the influence of gravity in patients with heart failure. Key Points: • This study showed that the superior vena cava (SVC) area in the standing position was most accurate in identifying patients with heart failure with higher mean right atrial pressure. • Upright computed tomography-based measurements of the SVC area can be a promising non-invasive method for estimating mean right atrial pressure under the influence of gravity in patients with heart failure. • Clinical management of patients with heart failure based on this non-invasive modality may lead to early assessment of conditional changes and reduced hospitalization for exacerbation of heart failure. [ABSTRACT FROM AUTHOR]

Preventing phrenic nerve injury (PNI) during balloon-based ablation is essential. The superior vena cava-right atrial (SVC-RA) junction is located just opposite the balloon position during right superior pulmonary vein (RSPV) ablation, and the phrenic nerve runs nearby on the lateral side. We compared the occurrence of PNI between the two balloon-based ablation systems and also the lesions created at the SVC-RA junction, which were expected to represent the effect on extra-PV structures. Cryoballoon ablation (CBA, n = 110) and hot-balloon ablation (HBA, n = 90) were performed in atrial fibrillation patients. High-density maps of the SVC-RA junction were created in 93 patients (CBA = 53, HBA = 40), and the damaged area (< 1.0 mV) was determined as an "SVC lesion". CBA had a higher occurrence of transient PNI (7.3% vs 1.1%, p = 0.035), but all recovered during the 6-month follow-up. An apparent SVC lesion was documented in 43% of the patients (40/93), and all patients with PNI had this lesion. CBA created a frequent (CBA vs HBA = 55% vs 28%, p = 0.008) and wider (0.8[0.4–1.7] cm2 vs 0.5[0.3–0.7] cm2, p = 0.005) SVC lesion than HBA. A multivariate analysis revealed that the use of a CBA system was a predictive factor of the occurrence of SVC lesions. CBA had a higher occurrence of transient PNI but not a permanent form. Every patient with PNI had lesions on the SVC-RA junction, and CBA revealed more substantial ablation effects at the SVC-RA junction than HBA. This may be caused by the different characteristics of the two balloon-based ablation systems and their balloon positions. [ABSTRACT FROM AUTHOR]

Transcatheter correction of superior sinus venosus defects using covered stent is increasingly reported in the literature and provides an alternative option to surgery in appropriately selected adults. Being a new intervention, meticulous attention to procedural techniques and precise surveillance imaging modalities are vital to detect and avoid potential early and late complications. This report highlights the occurrence of a residual interatrial communication following covered stent placement and large subclinical asymptomatic nonocclusive thrombus formation at the right atrial end of the stent. The management of both these complications is also highlighted in this report. [ABSTRACT FROM AUTHOR]

We present the imaging findings of thoracic systemic venous anomalies diagnosed by computed tomography and magnetic resonance imaging. Persistent left superior vena cava is the commonest anomaly of the thoracic systemic veins encountered either incidentally as an isolated finding or associated with congenital heart disease. Inferior vena cava (IVC) interruption with azygos continuation is the second most common anomaly, which may also be isolated or be associated with left isomerism syndrome. The article will also discuss other rarer systemic venous anomalies including retroaortic brachiocephalic vein and IVC drainage into the left atrium. Finally, the impact of pre-procedure reporting of thoracic systemic venous anomalies on the choice of intervention and patient outcome will be addressed. [ABSTRACT FROM AUTHOR]

Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25-year-old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography. [ABSTRACT FROM AUTHOR]

Bilateral absence of the superior vena cava is associated with rhythm and structural abnormalities and is diagnosed incidentally either during imaging procedures or venous catheterization or pacemaker implantation. Knowledge of this entity is important to allow proper referral, medical management of its associated abnormalities, and risk reduction in certain interventions. [ABSTRACT FROM AUTHOR]

A central venous catheter is a flexible catheter that is inserted into a vein and ends close to the superior vena cava. It may be inserted through a vein in the neck, chest, or arm. It's also called a central venous line or central line. Peripherally inserted central venous catheters (PICCs) are usually implanted in arm veins such as the basilic vein, the brachial veins or in some cases in the cephalic vein. PICCs can remain in place for up to six months or more. If properly managed, they last even more than a year. PICCs offer the advantage of greater safety for infusion of vesicants/ irritants and hyperosmolar solutions and enable the administration of antibiotics, prolonged parenteral nutrition, and chemotherapy agents. They are however, associated with some adverse events such as spontaneous late migration. The reasons for these complications are not yet fully understood. There are now established causes and in some cases hypotheses to explain these phenomena. We describe two clinical cases in which apparently correctly positioned PICCs migrated spontaneously from their original position. The identification of the migration of the vascular catheter was accidental in the two patients, and they did not developed complications. One of the two patients had a pacemaker. The remote migration of a PICC is an event that can occur, and the causes are not definitively clarified in all cases. [ABSTRACT FROM AUTHOR]

Oliguric patients with acute kidney injury (AKI) often requires an internal jugular vein or femoral venous catheter to establish vascular access for emergency hemodialysis. Puncture with catheterization (PC) of the right internal jugular vein (RIJV) is relatively simple and is often the first choice for hemodialysis catheters insertion. However, complications such as bleeding and hematoma at the puncture site can occur, and in rare cases, the hemodialysis catheter (HDC) can be misplaced into the internal carotid artery, subclavian artery, subclavian vein, or even the thoracic cavity and mediastinum, leading to intractability for processing next. In this study, we report a case of an elderly female patient with AKI who underwent RIJV puncture for long-term HDC because her renal function had not recovered in the short term, and the lower end of the catheter penetrated the superior vena cava (SVC) into the mediastinum due to operator's carelessness. We did not perform open surgery or endovascular interventions, and instead, the HDC was retained in that place for four weeks and then directly removed without surgery. The patient did not experience any problems, such as bleeding or hematoma, and has been receiving hemodialysis from femoral catheter subsequently since then. [ABSTRACT FROM AUTHOR]

Superior vena cava thrombosis with its extension into the right heart chambers can be commonly seen in the presence of chronically inserted catheters, coagulation disorders, malignancy, deep venous thrombosis (DVT), obesity, pregnancy, or trauma. Right atrial thrombi generally forms on injured endothelium due to implanted devices or foreign bodies, including tumors, pacemakers, and chronic right atrial catheters like triple-lumen catheters used for hemodialysis, giving chemotherapy, intravenous fluids or parenteral nutrition. It can lead to severe consequences, which may result in pulmonary or septic embolism and even systemic embolization as seen in the case of an atrial septal defect or patent foramen ovale. We report a case of a 49-year-old female who presented with complaints of mild to moderate dyspnea for 1 month with a past history of DVT and pulmonary embolism. She has undergone a gastric band procedure. Her imaging studies revealed a 42 x 20 mm intraluminal lesion within the Superior Vena Cava (SVC) extending into the right atrium. The patient's huge mass was removed by surgery, and pathological evaluation confirmed it to be thrombosis. [ABSTRACT FROM AUTHOR]

Intravascular lipomas (IVL) located in the superior vena cava (SVS) are rare benign primary venous tumors with less than 15 cases reported in the literature. We report a case of a 64-year-old woman with IVL of the SVC extending to the right brachiocephalic vein. She was treated successfully using a hybrid procedure which involved endovascular control of the right subclavian vein and surgical approach via median sternotomy followed by mass resection and use of pericardial patch for vein defect closure. [ABSTRACT FROM AUTHOR]

The presence of persistent left superior vena cava to the left atrium connection without an innominate vein may give rise to technical challenges during intracardiac repair. In this report, the end-to-side anastomosis technique of the persistent left superior vena cava to the right superior vena cava is discussed in a patient with tetralogy of Fallot associated with persistent left superior vena cava draining directly into the left atrium. A successful end-to-side anastomosis between the persistent left superior vena cava and the right superior vena cava was performed and short-term anastomosis patency was documented via angiography. [ABSTRACT FROM AUTHOR]

Background. Far-field electrograms from superior vena cava (SVC) can be present in right superior pulmonary vein (RSPV) after pulmonary vein (PV) isolation. Objectives. To analyze the characteristics of far-field SVC potentials in RSPV after PV isolation and the local anatomy difference between patients with and without the potentials. Methods. Patients undergoing PV isolation were retrospectively reviewed, contrast-enhanced computed tomography (CT) was performed before procedure for observing the anatomical relationship between RSPV and SVC. The prevalence and characteristics of far-field SVC electrograms were described and compared to far-field left atrial potentials at the nearest point along the linear ablation lesion. The anatomical proximity of RSPV and SVC on a 2-dimensional horizontal CT view was compared between patients with and without far-field SVC potentials. Results. Far-field SVC electrograms were observed in 35/92(38%) patients with an amplitude of 0.24 ± 0.11 mV and a major deflection slope of 0.051 ± 0.036 mV, both significantly higher than far-field left atrial electrograms (p <.001). In patients with far-field SVC electrograms, 83% had connected RSPV-SVC, defined as distance between RSPV and SVC endocardium less than 3 mm at the layer of RSPV ostium roof, while in patients without far-field SVC electrograms, 70% had disconnected RSPV-SVC. Conclusions. Far-field SVC electrograms appeared in RSPV had a prevalence higher than previously reported and a sharper major deflection compared to far-field left atrial electrograms. Connected RSPV-SVC on CT was associated with the presence of far-field SVC electrograms. [ABSTRACT FROM AUTHOR]

Background: In cardiac surgery, precision and efficiency are crucial, especially in managing venous drainage flows during complex procedures. This practical technique evaluates the benefits of placing the proximal junction on the cardiopulmonary bypass (CPB) side rather than on the surgical table in bicaval cannulation. Bicaval cannulation, involving both the superior vena cava (SVC) and inferior vena cava (IVC), ensures efficient venous return.Practical technique: Placing the junction on the CPB side allows for accurate, real-time control of venous drainage, allowing for swift responses to fluctuations and maintaining stable hemodynamics.Perspectives: This approach could minimize the risk of congestion in the liver, splanchnic system, and cerebral venous return, thereby preventing related complications. Another important potential benefit of this approach could be the ability to closely monitor and manage metabolic demands and oxygen consumption for SVC and IVC. Additionally, EmTec flow technology can be integrated for more precise management. [ABSTRACT FROM AUTHOR]

Superior vena cava syndrome is rare and challenging clinical entity in neonates. Medical treatment options are usually effective. However, when failed, surgery is warranted. Herein, we present a preterm neonate with SVC syndrome and associated chylothorax. When 2 weeks old, he underwent successful open thrombectomy and SVC reconstruction under cardiopulmonary bypass. Immediately after the operation findings of SVC syndrome and chylotorax were completely resolved. To our knowledge, this patient is the smallest baby underwent open SVC reconstruction with cardiopulmonary bypass. [ABSTRACT FROM AUTHOR]

Ectopic potentials in the SVC can act not only as a trigger but also as a driver of AF. These potentials may be refractory to conventional pulmonary vein isolation for AF. In the present case, the atrium resumed a sinus rhythm spontaneously on the completion of SVC isolation and AF could no longer be induced. However, there was residual fibrillatory activity in the SVC. These findings suggest that residual activity in the SVC worked as a driver of AF. SVC reconnection is commonly reported, with a prevalence of 70%. Thus, we decided to eliminate residual fibrillatory activity in the SVC to prevent recurrence of AF after the third catheter ablation session. In the presence of a fibrillatory pattern, conventional activation mapping techniques cannot map residual SVC activity; however, ICL mapping using the CARTO system can identify the target site of ablation in the isolated SVC. [ABSTRACT FROM AUTHOR]

The superior vena cava (SVC) is the main component of non-pulmonary vein (PV) ectopy in patients with atrial fibrillation (AF). Researchers have found that epicardial adipose tissue (EAT) volume is related to the AF substrate, which can be defined by the low voltage area (LVA). This study aimed to investigate the relationship between SVC-EAT and SVC-AF. Twenty-six patients with SVC-AF triggers were identified as the SVC-AF group. Other three groups were defined and included as the LVA-AF group (LVA>5%), non-LVA-AF group (LVA<5%), and physical examination (PE) group. EAT around left atrium (LA-EAT) and SVC-EAT volumes were obtained using a cardiac risk assessment module. According to the SVC/LA-EAT ratio, there are significant differences between the SVC-AF group and the three control groups (the SVC-AF group 0.092±0.041 vs. the LVA-AF group 0.054±0.026, the non-LVA-AF group 0.052±0.022, and the PE group 0.052±0.019, all P<0.001). Receiver operating characteristic curve analysis suggests the optimal cut-off point of SVC/LA-EAT ratio is 6.8% for detecting SVC-AF patients, with 81.1% sensitivity, 73.1% specificity, and an area under the curve of 0.83 (95% confidence interval, 0.75-0.91). Those with SVC-AF have a higher SVC/LA-EAT ratio and empirical SVC isolation could be considered if the SVC/LA-EAT ratio was over 6.8%. [ABSTRACT FROM AUTHOR]

Superior vena cava syndrome (SVCS) is an entity that has become more frequent due to the increasing use of indwelling central venous catheters. Surgical management is considered in patients with extensive venous thrombosis and when endovascular therapy is not feasible. The use of superficial femoral vein is an excellent technique for reconstruction of the brachiocephalic vein and superior vena cava (SVC) in cases with benign and malignant etiologies. We describe two cases of SVCS that were managed surgically at our institution with replacement of the SVC and brachiocephalic veins with a superficial femoral vein graft technique. [ABSTRACT FROM AUTHOR]

Background: Paroxysmal atrial fibrillation can be triggered by non-pulmonary vein foci, such as the superior vena cava. Here, we report the case of a patient with a 6-year history of paroxysmal atrial fibrillation who received cryoballoon ablation in 2012 but relapsed in 2014. He then received cardiac radiofrequency ablation, which successfully isolated the left pulmonary vein and superior vena cava, but the arrhythmia recently relapsed again. The tachycardia was finally successfully terminated by ablation on the free wall without recurrence during a 2-year following up. Conclusion: Superior vena cava isolation may not require ablation isolation with a full circle way and can be accomplished by ablating several connection points between the superior vena cava and the right atrium. [ABSTRACT FROM AUTHOR]

Background and Aims: The position of the tip of the central venous catheter (CVC) is important to minimise complications. The aim of our study was to compare modified Peres' height formula and landmark method using distance between puncture site and right third intercostal space (PS-RTICS) and to develop a reliable formula for correct positioning of tip of the CVC. Methods: This prospective, randomised study was conducted on 400 patients of either gender, of age 18 years and older, scheduled to undergo right internal jugular venous cannulation. Depending on the technique used for deciding the length of CVC to be inserted, the patients were randomly allocated into two groups: Group A, using modified Peres' height formula, that is, height of patient (cm)/10-2 and Group B, using distance between PS-RTICS and subtracting one from it, that is (PS-RTICS)-1. The carina was taken as the landmark for optimum insertion of CVC, which was confirmed on postprocedure chest X-ray. Data so obtained were tabulated and analysed. P<.05 was considered statistically significant for correlation and regression coefficients. Results: In group A, the mean length of catheter inserted was 15.18 ± 0.73 cm and the catheter tip was found to be 2.41 ± 0.85 cm distal to carina (P =0.001). Over-insertion was found in 98.45% patients in group A. In group B, the mean length of catheter inserted was 14.12 ± 0.85 cm and the catheter tip was found to be 0.20 ± 1.18 cm distal to carina. Conclusion: Though both landmark and modified Peres' height formula has low accuracy, landmark technique is superior in predicting correct depth of right internal jugular venous cannulation catheter. [ABSTRACT FROM AUTHOR]

Left subclavian venous access increases the risk of vascular damage and thrombosis based on the catheter course and location of the catheter tip. We investigated the accuracy of tip positioning with conventional landmarks using transesophageal echocardiography. The carina as a radiological landmark and the right third intercostal space as a topographical landmark were selected for tip positioning within the target zone, defined as 2 cm above and 1 cm below the right atrial junction. A total of 120 participants were randomized into two groups. The catheter insertion depth was determined as 1.5 cm more than the distance between the venous insertion point and the carina via the right first intercostal space in the radiological group, and between the venous insertion point and the right third intercostal space via the right first intercostal space in the topographical group. The determined insertion depth and actual distance to the right atrial junction of the radiological and topographical groups were 19.5 cm and 20.5 cm, and 19.8 cm and 20.4 cm, respectively. Acceptable positioning was more frequent in the topographical group (96.4% vs. 85.7%; p = 0.047). The catheter tip is more accurately positioned in the distal superior vena cava using topographical landmarks than radiological landmarks. [ABSTRACT FROM AUTHOR]

We report an extremely rare case of vincristine‑induced fibrotic obstruction of the upper superior vena cava (SVC) in a 42‑year‑old female. She recovered from non‑Hodgkin’s lymphoma 5 years back and presented with SVC syndrome. Our case is the first description of vascular toxicity of vincristine with SVC fibrotic obstruction. [ABSTRACT FROM AUTHOR]

Superior sinus venosus defect is characterized by varying degrees of override of the atrial septum by the superior vena cava and anomalous right upper pulmonary vein (RUPV) drainage. The defect is seen posterosuperior to the oval fossa and is traditionally corrected by a surgical patch that routes the anomalously draining RUPV to the left atrium. A few postoperative patients develop stenosis or occlusion of the caval or pulmonary vein and/or sick sinus syndrome secondary to vascular injury. This has kindled a recent interest in nonsurgical correction of these defects by the use of a covered stent to reroof the defect. The complex anatomy of this defect often necessitates the use of advanced imaging tools and postprocessing. Countries with restricted resources do not have easy access to technologies such as three-dimensional printed models and advanced processing like virtual reality or holography. This "How to do it?" article, applicable in these countries, explains the current understanding of this intervention, patient selection, step-by-step explanation of the evaluation, and stent implantation. [ABSTRACT FROM AUTHOR]

Both through dissections in cadaveric material and through imaging methods, multiple anatomical variants have been described in the vascular system, the superior cava system being no exception. These congenital or acquired modifications may difficult the performance of endovascular procedures, such as the placement of central venous lines. For safe performance of such procedures, knowledge of these variants is essential. This study reports the case of an individual with Ebstein's disease surgically corrected by a tricuspid valve replacement and bidirectional cavopulmonary anastomosis (Glenn procedure), who was admitted for placement of a long-term central venous device. Pre, intra and postoperative imaging studies allow mapping the patient's anatomy, planning and performing the surgical act as well as control of the devices placed during evolution. [ABSTRACT FROM AUTHOR]

The superior vena cava (SVC) is well described as one of the most common non‐pulmonary vein (PV)—triggers for atrial tachyarrhythmias (ATA). In our study we evaluated a standardized approach for electrical isolation of the SVC from the right atrium using a horseshoe‐shaped lesion set with optimized and contiguous ostial RF lesions. The results are promising, demonstrating a very high rate of acute SVC isolation in a safe and time efficient manner (mostly less than 10 min). [ABSTRACT FROM AUTHOR]

Background: Partial anomalous pulmonary venous connection (PAPVC) occurs when at least one pulmonary vein drains into the right atrium or its tributaries rather than the left atrium, most commonly connecting with the superior vena cava (SVC). The Warden procedure involves transecting the SVC proximal to the uppermost connection of the pulmonary vein followed by proximal SVC reattachment to the right atrial appendage. However, descending thoracic aortic homograft replacement for SVC translocation has recently been introduced as a modified technique. Aims: This commentary aims to discuss the recent study by Said et al. who reported their experiences with six PAPVC cases undergoing a modified Warden procedure using thoracic aortic homograft SVC translocation. Methods: A comprehensive literature search was performed using multiple electronic databases to collate the relevant research evidence. Results: The Warden procedure is associated with a 10% incidence of SVC obstruction with many requiring reintervention. Meanwhile, using the aortic homograft for SVC translocation, Said et al. observed no SVC obstructions. In addition, this modified technique does not require anticoagulation and has demonstrated an improvement in long‐term SVC patency. Nevertheless, it can be considered an expensive procedure. Moreover, since the thoracic aortic homograft utilized is biological tissue, only long‐term follow‐up will determine whether calcification and graft degeneration is an issue. Conclusion: It can be concluded that the modified Warden procedure is a safe and effective method to reconstruct the systemic venous drainage into the right atrium when a direct anastomosis under tension might be prone to re‐stenosis. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to determine the clinical effectiveness of a stent with radioactive seed strand (RSS) inserted in patients with superior vena cava (SVC) obstruction (SVCO) secondary to non-small-cell lung cancer (NSCLC). Methods: Between January 2013 and December 2019, 63 patients with SVCO related to NSCLC received stent implantation with (n = 30) or without (n = 33) RSS insertion at our center. The clinical efficacy, stent patency duration, and overall survival (OS) were compared between these two groups. Results: Both groups achieved 100% clinical and technical success rates. There were no obstacles associated with the procedure performed for the patients. Two patients in the RSS group and 7 patients in the stent-alone group experienced stent re-stenosis. The rate of re-stenosis between the two groups was not significantly different (P =.099). Patients in the RSS group had significantly longer median patency than those in the stent-alone group (381 vs 309 days, P =.045). All patients died because of the development of tumors during the follow-up. Patients in the RSS group had a significantly longer median OS than those in the stent-alone group (229 vs 178 days, P =.026). During the follow-up, no patient in the RSS group suffered RSS migration or brachytherapy-related complications. Conclusion: For patients with SVCO secondary to NSCLC, a stent with RSS insertion is efficacious and safe, and it may improve stent patency and OS. [ABSTRACT FROM AUTHOR]

Background Inferior vena cava (IVC) anomalies are rare and diagnosed incidentally as most patients are asymptomatic. We present a case where an abnormal course of the wire during percutaneous mitral valve repair revealed abnormal IVC anatomy leading to procedure termination. We summarized all IVC anomalies relevant to cardiovascular physicians and designed a simplified tool to illustrate their course for differential diagnosis. Case summary A 78-year-old female presented with severe and symptomatic mitral regurgitation. The heart team decided to proceed with a percutaneous option, considering the patient's high surgical risk. While ascending from the femoral vein, the wire took an abnormal course to the left side of the vertebrae and continued beyond the cardiac silhouette downwards the right atrium (RA). We decided to abort the procedure due to the high risk for vascular complications assuming the need to cross it with the device's delivery system. Retrospective computed tomography analysis revealed an interrupted IVC at the level of the renal vasculature and azygos continuation toward the RA via a dilated superior vena cava. The patient was referred to surgery and had successful mitral and tricuspid valve repair and was discharged home in good health. Discussion The increased number of minimally invasive percutaneous procedures, especially for valvular heart disease, mandates a profound understanding of the arterial, and venous system anatomy. Inferior vena cava anomalies represent a group of anomalies with different paths and variations and have a tremendous impact on all aspects of the procedure. [ABSTRACT FROM AUTHOR]

This article, published in the European Heart Journal Case Reports, discusses a case of successful removal of a superior vena cava (SVC) coil that was left alone in the innominate vein. The patient, a 56-year-old man with Brugada syndrome, had a delayed cardiac tamponade due to perforation of a defibrillation lead implanted 10 years ago. The lead was surgically repaired and resected, but a year later, the patient needed lead extraction due to pocket infection. The extraction was challenging because the distal end of the lead could not be captured by a snare catheter. However, a combined approach via the jugular and femoral veins was used to successfully remove the SVC coil. The article includes supplementary material and confirms that consent was obtained from the patient for publication. No funding was declared for this study, and the authors disclose their potential conflicts of interest. [Extracted from the article]

Open in new tab Download slide Open in new tab Download slide OBJECTIVES Direct involvement of the superior vena cava (SVC) by non-small cell lung cancer (NSCLC) requires en-bloc tumour resection with complete vascular clamping and prosthetic replacement. We report the outcomes of this highly demanding procedure in the largest patient cohort to date. METHODS We searched our institution's database for patients who underwent complete en-bloc resection of NSCLC invading the SVC followed by prosthetic SVC replacement, between 1980 and 2018. Patients with cN2, cN3 or distant metastases were not eligible. RESULTS We identified 48 patients (38 males, 10 females; mean age of 57 years; tumour size, 1.9–17 cm). Neoadjuvant therapy was administered to 17 and adjuvant therapy to 31 patients. R0 resection was achieved in 41 (85%) patients; lymph node involvement was pN0 in 8, pN1 in 23, pN2 in 14 and pN3 in 3 patients. Five patients died within 30 days of surgery. Right pneumonectomy was significantly associated with postoperative death (P  =   0.02). Postoperative complications developed in 13 other patients. No neurologic events related to SVC clamping occurred. Graft thrombosis developed in 2 patients. Median survival was 24 months; 3-, 5- and 10-year survival rates were 45%, 40% and 35%, respectively; and corresponding disease-free survival rates were 37%, 37% and 30%, respectively. By univariable analysis, only margin-free (R0) resection was associated with better survival (P  =   0.02). CONCLUSIONS In highly selected patients with NSCLC involving the SVC, mortality is acceptable after complete en-bloc resection and prosthetic replacement done in an expert centre. SVC involvement should not preclude consideration of curative resection in selected patients. [ABSTRACT FROM AUTHOR]