Coronary artery bypass and superior vena cava syndrome

Superior vena cava syndrome is the obstruction of the superior vena cava or its main tributaries by benign or malignant lesions. The syndrome causes edema and engorgement of the vessels on the face, neck, and arms, nonproductive cough, and dyspnea. We discuss the case of a 48-year-old obese diabetic woman who was admitted with unstable angina. She had previously been diagnosed with superior vena cava syndrome. Urgent coronary artery bypass grafting was necessary Although thousands of coronary artery bypasses are performed every year, there are not many reports on patients with superior vena cava syndrome who successfully undergo cardiopulmonary bypass and coronary artery grafting with an internal mammary artery as the conduit. The results of the case and alternative recommended methods are discussed.     

Use of cardiopulmonary bypass for thrombectomy in acute superior vena cava syndrome

An increasing incidence of nonmalignant, indwelling catheter cases has been reported in relation to superior vena cava syndrome. Such cases may be life-threatening, with rapid development of facial and neck edema and the production of respiratory distress. This is the first reported case of atrial and superior vena caval thrombectomy requiring cardiopulmonary bypass; it is only the second case reported in which operative thrombectomy has been used. Because of the problems associated with an increase in the use of indwelling venous catheters and the satisfactory results we obtained in this case, such an aggressive form of treatment for acute, benign superior vena cava syndrome may be used more frequently in the future.     

Spiral vein bypass for superior vena cava syndrome due to mediastinal fibrosis

A 22-year-old man underwent palliative surgery for superior vena cava syndrome due to a benign obstructive process compatible with fibrosing mediastinitis. By using a spiral vein constructed from autologous saphenous vein, an innominate vein to the right atrial appendage shunt was created. This technique, which was first described experimentally in 1974 and performed clinically in 1976, may warrant more liberal application in patients with superior vena cava syndrome caused by malignant and benign diseases.     

Obstruction of the superior vena cava after chemotherapy

Superior vena cava obstruction developed a few hours after the administration of chemotherapy for small-cell lung carcinoma. The syndrome responded rapidly to dexamethasone. Although the mechanisms of the appearance and resolution of the superior vena cava obstruction in this patient remain hypothetic, there is an important therapeutic implication.     

Superior vena caval bypass using the superficial femoral vein for treatment of superior vena cava syndrome

We present the case of a 71-year-old woman who had benign, symptomatic, superior vena cava syndrome that was treated with open surgical bypass using the superficial femoral vein. The patient had an uneventful hospital course and experienced relief of her symptoms. We conclude that the superficial femoral vein is an acceptable bypass conduit for open surgical management of superior vena cava syndrome.     

Bilateral superior vena cava with right superior vena cava draining into left atrium

Anomalies of systemic venous return are extremely heterogeneous congenital malformations with variable ranges from completely normal physiology to severe forms of right to left shunting requiring surgical treatment. Anomalous drainage of a right-sided superior vena cava (SVC) to the left atrium (LA) is one of the rarest variants of systemic venous return anomalies, characterized by right-to-left shunt physiology and cyanosis. Here we report a 2 years old girl presented with cyanosis which was observed shortly after birth by her parents but not further investigated. She is otherwise active girl and with normal growth and development. Her clinical examination was unremarkable apart from mild clubbing of the fingers and low oxygen saturation of 88–90% in room air. Her ECG and chest X-ray were unremarkable. Echocardiography showed bilateral SVC connected by a small innominate vein. The right SVC drains directly into the LA while the left SVC drains into the right atrium (RA) via a dilated coronary sinus. There is a small superior sinus venosus type atrial septum defect (ASD) with left to right shunt. Also, there is partial anomalous pulmonary venous return with right upper and right middle pulmonary veins draining directly into the right SVC, which is connected to LA. The right lower pulmonary vein and left pulmonary veins drain directly to LA. The rest of her echocardiography demonstrated normal heart structures and function. This patient was referred for surgical correction, including baffling of the right SVC to the RA and closure of the ASD. We describe this case to highlight the importance of recognizing this rare anomalous systemic venous connection as one of the very rare causes of cyanosis in the pediatric age group as well as at older age.     

Superior vena cava bypass

A case of superior vena cava obstruction due to carcinoma of unknown origin is reported. A superior vena cava bypass with polytetrafluoroethylene was performed by suturing the prosthesis to the left innominate vein and the right atrium, respectively. Long-term satisfactory results were achieved.     

Doppler superior vena cava flow evolution and respiratory variation in superior vena cava syndrome

BACKGROUND: Superior vena cava syndrome (SVCS) is a clinical expression of obstruction of blood flow through the superior vena cava. The patterns of the Doppler flow changes of superior vena cava (SVC), especially the respiratory effects on them have not yet been fully elucidated. This study was to examine SVC Doppler flow patterns and the respiratory effects on them in healthy subjects and patients with SVCS. METHODS: The SVC Doppler flow patterns of 18 normal human subjects and 22 patients with SVCS were analyzed at initial diagnosis and were followed up every 2 months for at least 11 months. RESULTS: Among the 22 patients, 5 patients with the tumor near the right atrium oppressing the inferior segment of the SVC had clear VR- and AR-waves, while in the other 17 patients the VR- and AR-waves disappeared or their outlines were vague. The respiratory variations of the S- and D-waves as a percentage change in inspiration compared to expiration in patient group were much lower than those in control group (S-wave: 1.67 +/- 3.32% vs. 15.65 +/- 16.15%, P = 0.0003; D-wave: 1.80 +/- 1.12% vs. 23.55 +/- 37%, P = 0.0087), which gradually became larger with treatment and showed no significant difference with those in control group after 7 months. CONCLUSIONS: The Doppler flows of the patients with SVCS correlate well with the images of CT scan of them. The respiratory variation of the S- and D-velocities could be used to evaluate the severity of SVC obstruction and its therapeutic effect.     

Persistent left superior vena cava

Persistent left superior vena cava -- a case report. A case of a 72-year-old female admitted for pacemaker implantation is presented. During the procedure, persistent left superior vena cava was found. Pacemaker was inserted via right subclavicular vein.