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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5761_Библиотеки_им_академика_М_И_Перельмана
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102
ab
c
Fig. 32.3 Moderate tricuspid regurgitation is evident by the apical four-chamber view ( a ) and the right ventricular infl ow view ( b ). The surface
of the tricuspid regurgitation is about 7 cm
2
( a ), its vena contracta is 5 mm, and its gradient is 44 mmHg ( c ). RA right atrium, RV right ventricle
ab
Fig. 32.4 The apical four-chamber view with some posterior angula-
tion shows a defect in the posterior portion of the interatrial septum
(IAS), in favor of an ASD (sinus venosus type) ( arrow ). The right upper
pulmonary vein ( curved arrow ) connects to both atria just at the site of
this defect ( a ). A turbulent fl ow across the IAS ( arrow ) is evident by
color Doppler study, and the right upper pulmonary vein connects to
this defect ( curved arrow ) ( b ). LA left atrium, RA right atrium
Case 32 Left Persistent Superior Vena Cava with Sinus Venosus Atrial Septal Defect
103
ab
Fig. 32.5 A dilated coronary sinus ( arrow ) is evident on transesophageal echocardiography (TEE) (long-axis view) by two-dimensional ( a ) and
color Doppler study ( b ). LA left atrium, LV left ventricle, AOV aortic valve
Fig. 32.6 The ASD (sinus venosus type) ( arrow ) below the SVC is
obvious on TEE (bicaval view). LA left atrium, RA right atrium, SVC
superior vena cava
Case 32 Left Persistent Superior Vena Cava with Sinus Venosus Atrial Septal Defect
104
Diagnosis
The patient was diagnosed with a left persistent SVC with an
ASD (sinus venosus type) in conjunction with an anomalous
venous return of two right pulmonary veins to the junction of
the SVC and both atria.
Lesson
1. When confronting a dilated coronary sinus, the confi rmation of a left persistent SVC requires an injection of agitated saline into the patient’s left arm. If there is a left
persistent SVC, the contrast appears fi rst in the coronary
sinus and then in the right ventricle. However, caution
should be exercised regarding the injection of agitated
saline in a patient suspicious of an ASD. Even though the
ASD shunt is usually left to right and there may be negative contrast in the right atrium, there is still the possibility of the passage of some blood from right to left, causing
a transient ischemic attack.
2. Sometimes, transthoracic echocardiography (fourchamber view) can visualize an ASD (sinus venosus type)
in the posterior part of the IAS and the right upper pulmonary vein.
Comment
The patient was referred for surgery.
a b
c
Fig. 32.7 The right pulmonary veins connect to the junction of the SVC and the left atrium on TEE (0°) at the base of the heart ( a , b ) and in the
bicaval view ( c ). SVC superior vena cava, LA left atrium, PV pulmonary vein
Case 32 Left Persistent Superior Vena Cava with Sinus Venosus Atrial Septal Defect
105
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_33, © Springer International Publishing Switzerland 2015
A 27-year-old woman presented with dyspnea on exertion
(functional class II) of 2-year duration.
Atrial Septal Defect (Sinus Venosus
Type) Below the Inferior Vena Cava
with a Partial Anomalous Pulmonary
Venous Return (Right Lower
Pulmonary Vein)
Case 33
a
c
b
Fig. 33.1 Transesophageal echocardiography (TEE) (bicaval view)
shows an atrial septal defect (ASD) (sinus venosus type) below the inferior
vena cava (IVC) by two-dimensional echocardiography ( arrow ) ( a ) and
color-fl ow study ( arrow ) ( b ). The Eustachian valve at the entrance of the
IVC is evident in this view ( curved arrow ) ( a and b ). This is a schematic
illustration of the ASD (sinus venosus type) below the IVC in this view ( c )
Electronic supplementary material The online version of this chapter
(doi:
10.1007/978-3-319-12934-1_33 ) contains supplementary material,
which is available to authorized users.
106
Diagnosis
The patient was diagnosed with an ASD (sinus venosus type)
below the IVC together with a connection between the right
lower pulmonary vein and the IVC.
Comment
The patient was referred for surgery.
Lesson
Although an ASD (sinus venosus type) is more frequently
seen below the superior vena cava, sometimes it appears below
the IVC with an abnormal right lower and middle pulmonary
venous return, which connects to the IVC [ 60 , 62 , 63 ].
a
b
Fig. 33.2 TEE (bicaval view) illustrates the entrance of the right lower
pulmonary vein ( arrow ) into the IVC ( a, b ). The Eustachian valve is
also evident at the entrance of the IVC ( double arrow ) ( a ). LA left
atrium, RA right atrium, SVC superior vena cava, IVC inferior vena
cava, RPA right pulmonary artery
Fig. 33.3 The ASD at the posterior part of the interatrial septum can be
seen on TEE (short-axis view) ( arrow ). LA left atrium, RA right atrium,
AO aorta
Case 33 Atrial Septal Defect (Sinus Venosus Type) Below the Inferior Vena Cava
107
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_34, © Springer International Publishing Switzerland 2015
A 44-year-old man presented with dyspnea on exertion
(functional class II).
Atrial Septal Defect (Sinus Venosus
Type) with a Partial Anomalous
Pulmonary Venous Return Diagnosed
by Subcostal Bicaval View
Case 34
ab
Fig. 34.1 Transthoracic echocardiography subcostal view demon-
strates the overriding of the superior vena cava (SVC) on the left and
right atria. There is an atrial septal defect (ASD) (sinus venosus type)
below the SVC ( arrow ) by two-dimensional echocardiography ( a ) and
color-fl ow Doppler ( b ). The Eustachian valve at the orifi ce of the infe-
rior vena cava (IVC) is evident ( curved arrow ) ( a ). ASDSV atrial septal
defect sinus venosus type, RA right atrium, LA left atrium, SVC superior
vena cava, RPA right pulmonary artery
Fig. 34.2 Transesophageal echocardiography (TEE) (bicaval view)
illustrates the ASD below the SVC ( arrow ) and the right upper pulmo-
nary vein ( curved arrow ), which connects to the junction between the
SVC and this defect by color-fl ow study. RA right atrium, LA left
atrium, SVC superior vena cava, RUPV right upper pulmonary vein
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_34 ) contains supplementary
material, which is available to authorized users.
108
Comment
The patient was referred for surgery after cardiac
catheterism.
Lesson
The subcostal bicaval view can help diagnose an ASD (sinus
venosus type) by transthoracic echocardiography.
Sometimes, the right upper pulmonary vein can also be visualized by this view. In adults, however, since it is not always
possible to obtain a good subcostal bicaval view, the marker
of the probe should be placed in a sagittal view.
Fig. 34.3 TEE (short-axis view) at the base of the heart demonstrates
the defect between the SVC and the left atrium ( arrow ) and the right
upper and middle pulmonary veins ( curved arrow ), which connect to
this defect by two dimensional ( a ) and after by, the phrase will be this
defect by two-dimensional ( a ) and color-fl ow study ( b ). LA left atrium,
SVC superior vena cava, RUPV right upper pulmonary vein, RMPV
right middle pulmonary vein
ab
Case 34 Atrial Septal Defect (Sinus Venosus Type) with a Partial Anomalous Pulmonary Venous
109
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_35, © Springer International Publishing Switzerland 2015
A 17-year-old boy was referred to our echocardiography
laboratory with a diagnosis of an unroofed coronary sinus.
He had dyspnea on exertion (functional class I) since
childhood.
Isolated Left Persistent Superior
Vena Cava
Case 35
Fig. 35.1 A dilated coronary sinus can be seen in this parasternal long-
axis view: the coronary sinus is 24 × 16 mm in size, and it is intact at its
origin. LA left atrium, LV left ventricle, RV right ventricle, AO aorta
Electronic supplementary material The online version of this
chapter (doi:
10.1007/978-3-319-12934-1_35 ) contains supplementary
material, which is available to authorized users.
110
Diagnosis
Isolated left persistent superior vena cava.
Recommendation
Given the absence of any associated anomaly, follow-up was
recommended for the patient.
Lesson
An isolated left persistent SVC does not need any intervention. Dilated coronary sinus may be due to (1) left persistent
superior vena cava, (2) abnormal left pulmonary venous
return drainage to coronary sinus, and (3) high right atrial
pressure due to pulmonary arterial hypertension or tricuspid regurgitation or right ventricular failure [ 60 , 64 ]. It is of
notice that left persistent superior vena cava and dilated
coronary sinus may coexist with obstructive left-sided
lesions [ 2 ].
Fig. 35.3 The modifi ed apical four-chamber view with posterior angu-
lation shows the intact coronary sinus ( arrow ) during its course. LV left
ventricle, CS coronary sinus
ab
Fig. 35.2 ( a , b ) Following a contrast injection, the coronary sinus
( arrow ) fi lls fi rst before the right ventricle ( curved arrow ): this is in
favor of a left persistent superior vena cava (SVC) ( a ). Also, no bubbles
appear in the left atrium and left ventricle, which is against the diagnosis of an unroofed coronary sinus in the parasternal long-axis view ( b ).
LA left atrium, RV right ventricle, AO aorta
Case 35 Isolated Left Persistent Superior Vena Cava
111
H. Sadeghian, Z. Savand-Roomi, Echocardiographic Atlas of Adult Congenital Heart Disease,
DOI 10.1007/978-3-319-12934-1_36, © Springer International Publishing Switzerland 2015
A 32-year-old man was referred for the evaluation of the
cause of a stroke. He had suffered an ischemic cerebral
stroke 2 months previously.
Left Persistent Superior Vena Cava
and Cerebral Stroke
Case 36
c
ab
Fig. 36.1 The parasternal long-axis view shows a dilated coronary
sinus and the hypertrophy of the interventricular septum ( a ). The coro-
nary sinus measures 13 × 16 mm ( b ). This is a schematic depiction of
the dilated coronary sinus ( c ) . LA left atrium, LV left ventricle, AO
aorta, DAO descending aorta, RV right ventricle, CS coronary sinus
Electronic supplementary material The online version of this chapter
(doi:
10.1007/978-3-319-12934-1_36 ) contains supplementary mate-
rial, which is available to authorized users.
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