A case report of aortic wall reconstruction utilizing heparin-coated temporary bypass tube and roller pump system]

A 51-year-old man with stage IIIB (T4N2M0) adenocarcinoma of the lung underwent left pneumonectomy and aortic wall resection. In this operation a heparin-coated tube and roller pump system were used. Advantages of a heparin-coated tube and roller pump system for temporary bypass are as follows. 1) simple operative procedure. 2) controllable bypass flow. 3) no need for anticoagulants.     

A simple bypass technique for superior vena cava reconstruction

Superior vena cava (SVC) clamping can be required during thoracic surgery for SVC replacement or repair. In such cases, bypass techniques can be necessary to avoid hemodynamic instability, cerebral venous hypertension and hypoperfusion. Here, we report a novel and simple SVC bypass technique which does not require full systemic heparinization, specialized cannulation techniques or pumping devices and which can be applied percutaneously in the preoperative phase or intraoperatively. The preoperative shunt consisted in two Swan-Ganz catheters inserted in the jugular and femoral veins and connected by perfusion tubing with a three way stopcock. The intraoperative shunt consisted of a Pruitt(?)-catheter inserted in the left innominate vein and connected to a femoral Swan-Ganz catheter by perfusion tubing. We validated our system in seven patients undergoing SVC reconstruction. We monitored the systemic arterial blood pressures, the heart rate and vasoactive peptide requirements throughout the procedure. We also determined the neurological status and the in-hospital morbidity and mortality for each patient. Using this bypass, SVC clamping caused no hemodynamic instability, no neurological impairments and no in-hospital complications or deaths. This simple temporary SVC bypass procedure is safe and avoids hemodynamic instability and cerebral venous hypertension.     

A case of malignant lymphoma of anterior mediastinum requiring superior vena cava reconstruction]

The patient was a 21-year-old female with malignant lymphoma of the anterior mediastinum, which was associated with superior vena cava (SVC) syndrome due to tumor invasion and tracheo-bronchial stenosis due to tumor compression. The bilateral brachio-cephalic vein and superior vena cava were resected with the tumor, and SVC reconstruction with a ringed expanded polytetrafluoroethylene (EPTFE) graft was performed between the right brachio-cephalic vein and SVC, and between the left brachio-cephalic vein and the right appendage. Postoperative anti-coagulant therapy was not performed. Postoperatively, SVC syndrome and the complaint of tracheo-bronchial stenosis disappeared promptly. Venography, which was performed 2 weeks postoperatively, presented patency between the right brachio-cephalic vein and SVC, but the graft between the left brachio-cephalic vein and the right appendage was obstructed. SVC reconstruction using a ringed EPTFE graft is considered to be significant for the improvement of resectability and the relief of clinical symptoms.     

Nonthrombogenic aortic and vena caval bypass using heparin-coated tubes

In twenty-five acute canine experiments polyvinyl chloride (PVC) tubes, both uncoated and coated with tridodecylmethylammonium chloride/heparin (TDMAC/heparin) complex, were tested in thoracic aortic bypass lasting five hours and in inferior vena caval bypass lasting thirty minutes. In aortic bypass, heparin-coated tubes were almost totally nonthrombogenic in contrast to uncoated tubes which had definite thrombus formation. Smoothly tapered tubes were significantly less thrombogenic than were hybrid tubes with junctions. Tube design, especially junction-free construction, was more important than heparin coating in preventing thrombus formation. In vena caval bypass heparin-coated tubes were totally nonthrombogenic in contrast to uncoated tubes which did show thrombus formation and thrombo-embolism. The smoothly tapered TDMAC/heparin-coated shunt tubes were successfully employed in four patients during thoracic aortic aneurysmal resection.     

Superior vena cava rupture during balloon angioplasty and stent placement to relieve superior vena cava syndrome: a case report

Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndrome for more than a decade. Complications are uncommon and usually of minor consequence. Three previous reports have described ruptures of the SVC during venoplasty with death on one occasion. We report a fourth case of SVC rupture during angioplasty and stenting that required immediate pericardiocentesis followed by open surgical repair via sternotomy for direct control and repair. An algorithm for rapid recognition and prompt intervention is described.     

Thymic undifferentiated carcinoma with resection of superior vena cava: report of a case

A case of a 75-year-old woman with thymic undifferentiated carcinoma was reported. Thymic carcinoma infiltrated the right pleura, epicardium, and superior vena cava. Total thymectomy with resection of the right pleura, epicardium, and superior vena cava was performed. The superior vena cava was reconstructed with a ringed Goretex. The patient received the chemotherapy such as CDDP, VDS and MMC, and also received radiation therapy (total 5,000 rad). The postoperative clinical course was uneventful. The definition and therapy of thymic carcinoma is unclear. We think that complete resection of carcinoma is necessary even if cancer infiltrates the superior vena cava.     

Spiral vein graft for obstruction of the superior vena cava: a case report

Catheter-induced superior vena caval thrombosis is a rare complication of the placement of transvenous pacemakers. The authors report such a case in a 44-year-old man. A composite spiral graft of saphenous vein was used to bypass the obstruction. It was anastomosed end to side to the innominate vein and then to the right atrial appendage. The patient improved remarkably immediately after the operation and had an uncomplicated postoperative course. The authors discuss the surgical technique involved and recommend for this rare condition an initial trial of anticoagulant therapy followed by bypass grafting, using the technique they describe, if anticoagulation fails.     

Superior vena cava obstruction bypass - an alternative technique using bovine pericardial conduit: a case report

An alternative technique of superior vena cava obstruction bypass using bovine pericardial conduit is described. The patient in this case had recurrent bilateral thrombophlebitis and thrombosed saphenous veins. Most of the surgical techniques reported in the literature so far have described the use of polyethylene terephthalate (Dacron) graft, polytetrafluoroethylene graft, autologous pericardial patch, and spiral vein graft. The use of synthetic grafts has been plagued with high rates of thrombosis. The pathology, clinical presentation, surgical technique, and outcome are discussed.     

Prosthetic azygo-atrial bypass for palliation of superior vena cava syndrome

We report a case of locally advanced excavated non-small cell lung cancer with superior vena cava (SVC) syndrome that underwent four cycles of induction chemotherapy. Due to early treatment failure and the impossibility applying radical radiotherapy, a decision was made to perform surgery. The patient underwent right intrapericardial pneumonectomy with en-bloc resection of the SVC, azygos vein and mediastinal lymph nodes. Prosthetic azygo-atrial bypass was then performed. The patient enjoys one year progression-free survival with patent graft and symptomatic relief of SVC syndrome.     

Successful treatment of prolonged superior vena cava syndrome with thrombolytic therapy: A case report

Superior vena cava (SVC) syndrome is most commonly due to direct compression of the SVC by a tumor. Recently, there has been an increase in the number of cases of SVC syndrome associated with chronic indwelling central venous catheters. We present a case history of a patient with prolonged symptoms of SVC syndrome that was successfully treated with catheter-directed (intraclot) infusion thrombolytic therapy with urokinase. The treatment, prevention, and incidence of SVC syndrome caused by thrombosis associated with catheters is discussed. (J V ASC S URG 1994;20:108-13.)     

Permanent pacemaker implantation in the absence of a right superior vena cava. A case report.

In a patient with syncope and sinus bradycardia the left superior vena cava drained into the right atrium via the coronary sinus. He underwent permanent transvenous pacemaker implantation via the tortuous left superior vena-caval route, and has continued to show normal pacing over an 18-month follow-up period. The problem of pre-operative recognition and the optimum means of permanent and temporary pacing in this condition are discussed.     

A surgical case of combined valvular disease complicated by absent right superior vena cava and persistent left superior vena cava.

A 74-year-old man with combined valvular disease with a recent cerebral infarction was admitted. While undergoing thorough examination for valvular disease, absent right superior vena cava (RSVC) and persistent left superior vena cava (PLSVC) were recognized. Chest X-ray film suggested a right arch protrusion, and CT and venogram confirmed the diagnosis. During surgery, replacement of the mitral and aortic valves and annuloplasty of the tricuspid valve were performed. A blood draining cannula was inserted in retrograde fashion from the coronary sinus into the PLSVC, without any difficulties in the tricuspid valve repair. Due to bradycardic atrial fibrillation, we believed that it would be difficult to insert an endocardial electrode postoperatively, hence myocardial electrode was placed in the right ventricular wall. Absent RSVC combined with PLSVC is very rare, and a patient who underwent combined valve surgery with this rare anatomical abnormality is herein presented.