Focal source of atrial fibrillation arising from the ostium of the inferior vena cava.

A patient presented with paroxysmal atrial fibrillation (AF) caused by focal rapid discharges arising from the ostium of the inferior vena cava (IVC). Surface ECG showed typical features of AF and flutter when rapid activation at the IVC ostium was conducted to the right atrium in a 1-to-1 and 2-to-1 fashion, respectively. Discrete radiofrequency energy applications at the medial ostium of the IVC completely eliminated the atrial tachyarrhythmias.     

Partial obstruction of the inferior vena cava after surgery for left atrial myxoma

We present a case of iatrogenic partial obstruction of the inferior vena cava after removal of a left atrial myxoma. The closure occurred subsequent to repair of a discontinuity between the right atrium and inferior vena cava caused by excessive traction on frail tissues.     

Leiomyosarcoma of the inferior vena cava

A case of leiomyosarcoma of the inferior vena cava in a 74 year old woman is reported. The clinical and pathological features are described and the outcome and response to treatment analysed. This is a very rare form of malignant disease (less than 100 published cases) which mainly affects elderly women. The diagnosis is often made at a late stage because the symptomatology is not specific and because the tumour is so rare. Treatment is mainly surgical and is only possible in the infrarenal part of the inferior vena cava. It is very difficult or impossible to operate on the upper part of the vessel. The prognostic is poor. There are no reports of survival after 5 years.     

Atrial tachycardia originating from the hepatic segment of inferior vena cava in interruption of inferior vena cava with azygos continuation

Interruption of inferior vena cava (IVC) with azygos continuation is a rare venous anomaly, and arrhythmogenic IVC is also rarely reported. Arrhythmogenicity of the hepatic segment of IVC in interruption of IVC has never been reported. We describe the case of a 37-year-old female with interrupted left IVC with azygos continuation to right superior vena cava and atrial tachycardia originating from the hepatic segment of IVC.     

Contrast echocardiography of the inferior vena cava

M-mode and two-dimensional subcostal contrast echocardiography were used in 67 patients and 10 normal subjects to evaluate the contrast echo effect on the inferior vena cava echogram in relation to the cardiac cycle and respiratory events. No contrast echoes were recorded in the inferior vena cava in normals during normal breathing. Contrast echoes were recorded entering the inferior vena cava in systole in 20 patients with tricuspid regurgitation and in pre-systole in patients with atrial septal defect and left-to-right shunt and in some of the patients with elevated right atrial and ventricular end-diastolic pressure. Forced inspiration increased the contrast echo effect and determined the penetration of microbubbles into the inferior vena cava. This latter feature occurred in all the patients and only in 1 normal subject. The entry of the contrast echoes into the inferior vena cava was attributed to the high right atrial ventricular end-diastolic pressure and to the reversed flow, from the right ventricle to the right atrium and inferior vena cava in tricuspid regurgitation and from the left atrium to the inferior vena cava in atrial septal defect. The contrast echocardiographic diagnosis of tricuspid regurgitation appeared to be most reliable. New encouraging results were obtained by this technique in diagnosing atrial septal defect and left-to-right shunt. The first appearance of the contrast, the time of appearance in relation to the cardiac cycle and the direction of the to and fro motion of contrast echoes were the most important factors considered for a correct diagnosis.     

Trauma-induced thrombosis of the inferior vena cava

A 25 year old foreign patient, in his native country had a blunt polytrauma of the abdomen and of the thigh. The consequence was a complete thrombosis of the vena cava inferior in a distal position to the junction with the liver veins. The diagnosis was realized with phlebography, angiography and computertomography. The diaphragmatic part of the vena cava inferior and the liver veins were not affected by the thrombosis. The increasing edemas of the shank and a stasis ulcer which were the reason for the patients admission to the hospital could be treated successfully by Furosemid and Phenprocoumon within a period of 4 weeks.     

Aneurysmal dilatation of the inferior vena cava

Aim: Inferior vena cava aneurysms (IVCA) are rare, unlike aortic aneurysms. The diagnosis and treatment is challenging. This study defines clinical and echocardiographic findings in a prospective cohort of sixteen patients with fusiform IVCA. Methods and Results: All patients referred to the Mayo Clinic between January 2006 and July 2009 for a clinically indicated echocardiogram (36,128 patients) were screened for a dilated IVC. Sixteen cases of fusiform IVCA were identified. Eleven cases (68.8%) were female. Mean age at presentation was 76 years (range 51–89). Eleven (68.8%) had structural heart disease: with right ventricular (RV) dysfunction in 45.5% (n = 5), moderate or greater tricuspid regurgitation (TR) was seen in 36.4% (n = 4) and RV enlargement was seen in 18.2% (n = 2). The most common clinical indication for echocardiography was dyspnea (25%; n = 4) and heart failure (18.8%; n = 3). The mean IVCA diameter was 4.1 cm (range 3.8–5 cm) and the mean length of the aneurysms was 6.2 cm (range 3.5–8.7 cm), with mean right ventricular systolic pressure of 55 mmHg (range 31–105 mmHg). Five (31.3%) had at least a moderate reduction in right ventricular ejection fraction and five (31.3%) had significant TR. Among these five patients with significant TR, severe TR was present in 80%; (n = 4) and moderate to severe TR was present in 20%; (n = 1). Conclusions: IVC aneurysms are more common in the elderly, and is associated with an increase in right sided heart pressures, significant TR, and RV dysfunction. (Echocardiography 2011;28:833‐842)