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Coronary sinus aneurysm associated with multiple venous anomalies

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ABSTRACT

Background: Congenital anomalies of the venous system are rare, involve the inferior vena cava (IVC), a persistent left superior vena cava (PLSVC), and the left hepatic vein (LHV), and can make cardiac diagnostic and therapeutic procedures difficult.

Case presentation: We present a 67-year-old woman without heterotaxy syndrome associated with interruption of the left IVC that continued with the hemiazygos vein system, a PLSVC, and an anomalous LHV draining the into coronary sinus (CS). The venous anomalies caused a CS aneurysm. The anomalies were demonstrated by echocardiography and the diagnosis was established by contrast-enhanced computed tomography. Three days later, a coronary artery bypass graft was performed, which confirmed the diagnosis. Half a month after surgery, the pain had been relieved and the patient was discharged from the hospital.

Conclusion: Echocardiography is a useful modality to diagnose and assess anomalies of the CS, including CS aneurysms. Congenital anomalies of the venous system in this case were all due to embryonic development abnormalities. Contrast-enhanced computed tomography provides a more comprehensive view of the entire course of abnormal veins.

Electronic supplementary material: The online version of this article (doi:10.1186/s12872-017-0532-3) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

Thoracic and abdominal enhanced computed tomography demonstrating (a) A left IVC posterolateral to the abdominal aorta, converged by two renal veins (yellow arrow). b The left IVC gradually becomes thin, and continues with an enlarged hemiazygos vein (yellow arrow). Visceral position is normal. c The tiny azygos vein can be seen anterior to the vertebra, then crosses over the aorta and drains into the R-SVC (yellow arrow). The hemiazygos vein continues as the left superior intercostal vein via the accessory hemiazygos vein. The left superior intercostal vein eventually drained into the PLSVC at the level of the pulmonary artery bifurcation (red arrow). d In the left atrioventricular groove, a huge CS connected with the RA. e Reconstructive 3D imaging gives a better view of this anomaly. Ao: aorta; Az: azygos vein; CS: coronary sinus; HAV: hemiazygos vein; IVC: inferior vena cava; LV: left ventricle; PA: pulmonary artery; PLSVC: persistent left superior vena cava; RA: right atrium; R-SVC: right superior vena cava; RV: right ventricle
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Fig2: Thoracic and abdominal enhanced computed tomography demonstrating (a) A left IVC posterolateral to the abdominal aorta, converged by two renal veins (yellow arrow). b The left IVC gradually becomes thin, and continues with an enlarged hemiazygos vein (yellow arrow). Visceral position is normal. c The tiny azygos vein can be seen anterior to the vertebra, then crosses over the aorta and drains into the R-SVC (yellow arrow). The hemiazygos vein continues as the left superior intercostal vein via the accessory hemiazygos vein. The left superior intercostal vein eventually drained into the PLSVC at the level of the pulmonary artery bifurcation (red arrow). d In the left atrioventricular groove, a huge CS connected with the RA. e Reconstructive 3D imaging gives a better view of this anomaly. Ao: aorta; Az: azygos vein; CS: coronary sinus; HAV: hemiazygos vein; IVC: inferior vena cava; LV: left ventricle; PA: pulmonary artery; PLSVC: persistent left superior vena cava; RA: right atrium; R-SVC: right superior vena cava; RV: right ventricle

Mentions: A 67-year-old woman had intermittent chest pain for 1 year. She underwent coronary angiography and was diagnosed with significant coronary artery disease involving three main coronary arteries at the referring hospital. All three main coronary arteries had stenotic changes. She presented to our hospital for a coronary artery bypass graft. At the time of the clinical examination, the pulse rate was 85 beats/min and the blood pressure was 132/84 mmHg. No murmurs were auscultated. The electrocardiogram showed persistent atrial fibrillation with abnormal ST segment changes. Echocardiography demonstrated a dilated CS (Fig. 1). Thoracic and abdominal contrast-enhanced computed tomography was performed on a 64-detector row scanner (Siemens, Forchheim, Germany). Images were obtained during patient breath-holding using the following acquisition parameters: 120 kV; 240 mA; and 1.5-mm thick contiguous section. The patient received 80 mL of contrast media (Iohexol 350; GE Healthcare, Shanghai, China) using a power injector at 3.5 mL/s, and the time delays from injection of the contrast agent to scanning were approximately 20 s and 60 s for the arterial and venous phases, respectively. Thoracic and abdominal contrast-enhanced computed tomography revealed interruption of the left IVC that continued with the hemiazygos vein system, a PLSVC, and an anomalous LHV draining into the CSA (Figs. 2 & 3; Additional file 1: Movie 1). Considering her advanced age, the physicians did not plan to correct the venous anomalies. Three days later, a coronary artery bypass graft was performed, which confirmed the diagnosis. Half a month after the surgery, the pain was relieved and the patient was discharged from the hospital.Fig. 1


Coronary sinus aneurysm associated with multiple venous anomalies
Thoracic and abdominal enhanced computed tomography demonstrating (a) A left IVC posterolateral to the abdominal aorta, converged by two renal veins (yellow arrow). b The left IVC gradually becomes thin, and continues with an enlarged hemiazygos vein (yellow arrow). Visceral position is normal. c The tiny azygos vein can be seen anterior to the vertebra, then crosses over the aorta and drains into the R-SVC (yellow arrow). The hemiazygos vein continues as the left superior intercostal vein via the accessory hemiazygos vein. The left superior intercostal vein eventually drained into the PLSVC at the level of the pulmonary artery bifurcation (red arrow). d In the left atrioventricular groove, a huge CS connected with the RA. e Reconstructive 3D imaging gives a better view of this anomaly. Ao: aorta; Az: azygos vein; CS: coronary sinus; HAV: hemiazygos vein; IVC: inferior vena cava; LV: left ventricle; PA: pulmonary artery; PLSVC: persistent left superior vena cava; RA: right atrium; R-SVC: right superior vena cava; RV: right ventricle
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5382506&req=5

Fig2: Thoracic and abdominal enhanced computed tomography demonstrating (a) A left IVC posterolateral to the abdominal aorta, converged by two renal veins (yellow arrow). b The left IVC gradually becomes thin, and continues with an enlarged hemiazygos vein (yellow arrow). Visceral position is normal. c The tiny azygos vein can be seen anterior to the vertebra, then crosses over the aorta and drains into the R-SVC (yellow arrow). The hemiazygos vein continues as the left superior intercostal vein via the accessory hemiazygos vein. The left superior intercostal vein eventually drained into the PLSVC at the level of the pulmonary artery bifurcation (red arrow). d In the left atrioventricular groove, a huge CS connected with the RA. e Reconstructive 3D imaging gives a better view of this anomaly. Ao: aorta; Az: azygos vein; CS: coronary sinus; HAV: hemiazygos vein; IVC: inferior vena cava; LV: left ventricle; PA: pulmonary artery; PLSVC: persistent left superior vena cava; RA: right atrium; R-SVC: right superior vena cava; RV: right ventricle
Mentions: A 67-year-old woman had intermittent chest pain for 1 year. She underwent coronary angiography and was diagnosed with significant coronary artery disease involving three main coronary arteries at the referring hospital. All three main coronary arteries had stenotic changes. She presented to our hospital for a coronary artery bypass graft. At the time of the clinical examination, the pulse rate was 85 beats/min and the blood pressure was 132/84 mmHg. No murmurs were auscultated. The electrocardiogram showed persistent atrial fibrillation with abnormal ST segment changes. Echocardiography demonstrated a dilated CS (Fig. 1). Thoracic and abdominal contrast-enhanced computed tomography was performed on a 64-detector row scanner (Siemens, Forchheim, Germany). Images were obtained during patient breath-holding using the following acquisition parameters: 120 kV; 240 mA; and 1.5-mm thick contiguous section. The patient received 80 mL of contrast media (Iohexol 350; GE Healthcare, Shanghai, China) using a power injector at 3.5 mL/s, and the time delays from injection of the contrast agent to scanning were approximately 20 s and 60 s for the arterial and venous phases, respectively. Thoracic and abdominal contrast-enhanced computed tomography revealed interruption of the left IVC that continued with the hemiazygos vein system, a PLSVC, and an anomalous LHV draining into the CSA (Figs. 2 & 3; Additional file 1: Movie 1). Considering her advanced age, the physicians did not plan to correct the venous anomalies. Three days later, a coronary artery bypass graft was performed, which confirmed the diagnosis. Half a month after the surgery, the pain was relieved and the patient was discharged from the hospital.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Congenital anomalies of the venous system are rare, involve the inferior vena cava (IVC), a persistent left superior vena cava (PLSVC), and the left hepatic vein (LHV), and can make cardiac diagnostic and therapeutic procedures difficult.

Case presentation: We present a 67-year-old woman without heterotaxy syndrome associated with interruption of the left IVC that continued with the hemiazygos vein system, a PLSVC, and an anomalous LHV draining the into coronary sinus (CS). The venous anomalies caused a CS aneurysm. The anomalies were demonstrated by echocardiography and the diagnosis was established by contrast-enhanced computed tomography. Three days later, a coronary artery bypass graft was performed, which confirmed the diagnosis. Half a month after surgery, the pain had been relieved and the patient was discharged from the hospital.

Conclusion: Echocardiography is a useful modality to diagnose and assess anomalies of the CS, including CS aneurysms. Congenital anomalies of the venous system in this case were all due to embryonic development abnormalities. Contrast-enhanced computed tomography provides a more comprehensive view of the entire course of abnormal veins.

Electronic supplementary material: The online version of this article (doi:10.1186/s12872-017-0532-3) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus