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Venoatrial Abnormalities

  • Henryk KafkaEmail author
  • Raad H. Mohiaddin
Chapter

Abstract

Congenital venous anomalies of the thorax may be encountered in patients with documented congenital heart disease, those patients with abnormal echocardiographic findings (dilated right ventricle or pulmonary hypertension, for example), or unexpectedly, in patients having CT scan or magnetic resonance examination of the thorax for other reasons. These anomalies can range from the clinically important (partial anomalous pulmonary venous connection) to the clinically inconsequential (persistent left superior vena cava) and it is essential for the reading physician to be able to identify these anomalies and associated intracardiac or extracardiac defects in order to decide whether further imaging and investigation is warranted.

Keywords

Inferior Vena Cava Pulmonary Vein Superior Vena Cava Cardiac Magnetic Resonance Imaging Azygos Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

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Movie 4.1 Twenty-year old woman who had repair of a supracardiac TAPVC in infancy and is assessed for increasing dyspnea and Xray evidence of heart failure. (a) Single shot turbo spin echo axial image demonstrating the posterior location of the horizontal pulmonary venous confluence (HVC). (b) Contrast-enhanced Magnetic Resonance Angiography: Maximum intensity projection (mip) coronal image. This demonstrates the connections of the four pulmonary veins into the HVC. (c) Sagittal still image from SSFP cine confirming the superior location of the HVC and stenosis of the orifice between the HVC and the left atrium (LA). Note the hypertrophied right ventricle (RV). (d) Coronal still image from SSFP cine demonstrating the stenotic orifice and the turbulent flow into the LA (arrow) from the HVC. SSFP cines for (cand d) are available as supplemental images (AVI 3339 KB)
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Movie 4.2 Twenty-year old woman who had repair of a supracardiac TAPVC in infancy and is assessed for increasing dyspnea and Xray evidence of heart failure. (a) Single shot turbo spin echo axial image demonstrating the posterior location of the horizontal pulmonary venous confluence (HVC). (b) Contrast-enhanced Magnetic Resonance Angiography: Maximum intensity projection (mip) coronal image. This demonstrates the connections of the four pulmonary veins into the HVC. (c) Sagittal still image from SSFP cine confirming the superior location of the HVC and stenosis of the orifice between the HVC and the left atrium (LA). Note the hypertrophied right ventricle (RV). (d) Coronal still image from SSFP cine demonstrating the stenotic orifice and the turbulent flow into the LA (arrow) from the HVC. SSFP cines for (cand d) are available as supplemental images (AVI 3339 KB)
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Movie 4.3 Cor triatriatum.Cine MRI images (balanced steady state free precession sequences) acquired in transaxial plane through the left atrium (left) and in the left ventricular outflow tract (right). Arrowindicates cor triatriatum membrane. Note the anomalous right pulmonary venous connection to the azygos vein (asterisk). The movement of the membrane and the flow through the membrane can be better appreciated in the cine loops (Adapted from Locca et al. [13]. With permission from Elsevier13) (AVI 4050 KB)
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Movie 4.4 Cor triatriatum.Cine MRI images (balanced steady state free precession sequences) acquired in transaxial plane through the left atrium (left) and in the left ventricular outflow tract (right). Arrowindicates cor triatriatum membrane. Note the anomalous right pulmonary venous connection to the azygos vein (asterisk). The movement of the membrane and the flow through the membrane can be better appreciated in the cine loops (Adapted from Locca et al. [13]. With permission from Elsevier13) (AVI 4505 KB)
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Movie 4.5 Pulmonary vein stenosis.(a) Twenty-five year old woman with dyspnea. Still axial image from a SSFP cine demonstrates stenosis (arrow) at the connection of the left lower pulmonary vein to the left atrium. This can be better appreciated on the SSFP cine and corresponding phase contrast flow study (supplemental cine files). (b) Thirty-four year old woman with dyspnea and dilated pulmonary artery on echocardiography. Contrast-enhanced MR angiography coronal image. Arrowspoint to the stenoses of the right lower and right upper pulmonary veins at the left atrium. Aoaorta (AVI 5151 KB)
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Movie 4.6 Pulmonary vein stenosis.(a) Twenty-five year old woman with dyspnea. Still axial image from a SSFP cine demonstrates stenosis (arrow) at the connection of the left lower pulmonary vein to the left atrium. This can be better appreciated on the SSFP cine and corresponding phase contrast flow study (supplemental cine files). (b) Thirty-four year old woman with dyspnea and dilated pulmonary artery on echocardiography. Contrast-enhanced MR angiography coronal image. Arrowspoint to the stenoses of the right lower and right upper pulmonary veins at the left atrium. Aoaorta (AVI 6438 KB)
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Movie 4.7 PAPVC flow studies. Fifty-seven-year-old man with sinus venosus defect and right partial anomalous pulmonary venous connection. LAleft atrium, RAright atrium, RPAright pulmonary artery, RVright ventricle. (aand b) Oblique axial steady-state free precession cine image (a) shows anomalous connection of right upper pulmonary vein (arrowhead). Sinus venosus defect (arrow) is also evident at this level. Bright white signal in this velocity flow map (b) confirms flow from pulmonary vein into RA. (cand d) Coronal steady-state free precession cine image (c) shows connection of right pulmonary vein to RA–superior vena cava junction (arrowhead). Dark signal in this velocity flow map (d) shows flow (arrowhead) from anomalous pulmonary vein into RA. The cines from which these stills are derived can be viewed as supplemental files (Reprinted with permission from Kafka and Mohiaddin [9]) (AVI 4611 KB)
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Movie 4.8 PAPVC flow studies. Fifty-seven-year-old man with sinus venosus defect and right partial anomalous pulmonary venous connection. LAleft atrium, RAright atrium, RPAright pulmonary artery, RVright ventricle. (aand b) Oblique axial steady-state free precession cine image (a) shows anomalous connection of right upper pulmonary vein (arrowhead). Sinus venosus defect (arrow) is also evident at this level. Bright white signal in this velocity flow map (b) confirms flow from pulmonary vein into RA. (cand d) Coronal steady-state free precession cine image (c) shows connection of right pulmonary vein to RA–superior vena cava junction (arrowhead). Dark signal in this velocity flow map (d) shows flow (arrowhead) from anomalous pulmonary vein into RA. The cines from which these stills are derived can be viewed as supplemental files (Reprinted with permission from Kafka and Mohiaddin [9]) (AVI 4611 KB)
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Movie 4.9 Sinus venosus defect with PAPVC – velocity flow maps. (aand b) Transverse images in 32-year-old man with sinus venosus defect. Steady-state free precession cine image (a) shows sinus venosus defect (black arrow) between left atrium (LA) and superior vena cava (SVC) (asterisk). Corresponding in-plane velocity flow map (b) shows dark inflow from pulmonary vein (white arrow) into LA crossing sinus venosus defect and entering the SVC. (cand d)Sagittal images in 35-year-old woman with sinus venosus defect. Steady-state free precession cine frame (c) shows superior nature of sinus venosus defect (arrow) between LA and SVC (asterisk). Corresponding in-plane velocity flow map (d) shows dark inflow from LA across sinus venosus defect (arrow) into right atrium (RA). (eand f) Coronal images in 18-year-old woman with sinus venosus defect. FLASH image (e) shows bright flow disturbance in SVC (asterisk) related to flow through sinus venosus defect. Through-plane velocity flow map (f) in same position as (e) shows sinus venosus defect as dark region of flow (arrow) from LA. Aoaorta. (f) Is available to be viewed as a cine in the supplemental files (Reprinted with permission from Kafka and Mohiaddin [9]) (AVI 338 KB)
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Movie 4.10 Left superior vena cava. Still image from SSFP cine LVOT view demonstrating dilated coronary sinus (white arrow) posterior to the left atrium (LA). (a) Still image from SSFP cine transverse view. The left superior vena cava (LSVC) is seen anterior to the left pulmonary artery. (b) Still image from SSFP cine sagittal oblique demonstrates the LSVC entering the dilated coronary sinus (white arrow) and flowing into the right atrium (RA). The cine from which this still is derived is available as a supplemental file. Aoascending aorta, DAdescending aorta, RSVCright superior vena cava, PAmain pulmonary artery (AVI 5721 KB)
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Movie 4.11 Interrupted IVC with azygos continuation.Adult female presented with PSVT. She was referred for ablation but the right atrium could not be accessed via the femoral vein route. On MR imaging she was found to have an interrupted IVC with azygos continuation. (a) SSFP bright blood sagittal image demonstrating the dilated azygos vein (arrow) and azygos arch connecting to the superior vena cava (*). Note absence of the intrahepatic IVC. (b) SSFP bright blood coronal image demonstrating the double arch appearance with the dilated azygos vein (arrow) on the right of the aorta (Ao). (c) SSFP bright blood axial image at the level of the pulmonary artery (PA) bifurcation demonstrating the dilated azygos vein (arrow) and superior vena cava (*). (d) SSFP bright blood axial image caudal to plane of (c) demonstrating the azygos arch and the aortic arch. SSFPsagittal plane cine is available as supplemental file (AVI 4481 KB)

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Copyright information

© Springer-Verlag London 2012

Authors and Affiliations

  1. 1.Departments of Cardiology and RadiologyQueen’s University, Kingston General HospitalKingstonCanada
  2. 2.Cardiovascular Magnetic Resonance UnitRoyal Brompton Hospital and National Heart and Lung Institute, Imperial College LondonLondonUK

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