Persistência da veia cava superior esquerda e implante de dispositivos cardíacos eletrônicos / Persistent left superior vena cava and implant of electronic cardiac devices

Fundamento: A persistência da veia cava superior esquerda (PVCSE), embora rara, é a anomalia venosa mais comumente encontrada no tórax. Quando identificada durante procedimentos de implante de dispositivos cardíacos eletrônicos implantáveis (DCEI), pode ser um desafio para a técnica. Objetivo: Avaliar os casos descritos na literatura de implantes de todos os tipos de DCEI em portadores dessa anomalia venosa. Método: Após dois implantes bem sucedidos de cardiodesfibriladores implantáveis de dupla-câmara em pacientes com PVCSE, buscou-se descrever os casos existentes na literatura de implante de DCEI em portadores de PVCSE nas bases de dados do PubMed e Lilacs. Os critérios de inclusão foram: artigos em inglês ou português publicados na íntegra sobre a PVCSE em pacientes submetidos a implantes de marcapassos (MP), cardiodesfibriladores (CDI) e ressincronizadores cardíacos associados ou não ao CDI (TRC-D e TRC). Foram descritos o tipo de dispositivo implantado, o número de casos, os dados clínicos dos pacientes, a presença ou ausência de veia cava superior direita...

Persistent left superior vena cava (PLSVC), although a rare case, is the most common thoracic venous anomaly. It may be observed during implantable electronic cardiac devices (IECD) implantation and is challenge for the technique. Objective: After two successful implants of implantable dual-chamber cardiac defibrillator in patients with PLSVC, the objective of this study is to evaluate the existing scientific literature on all types of IECDs in patients with this venous anomaly. Methods: Describe cases of IECD implantation in patients with PLSVC reported in the literature obtained from searches in the PubMed and Lilacs database. For the inclusion criteria we analyzed full articles on PLSVC in patients submitted to pacemaker (PM), cardiac defibrillator (ICD) and cardiac resynchronization implantation associated or not to the ICD (CRT-D and CRT) in humans, published both in English or Portuguese. We describe the type of implanted device, the number of cases, clinical data of patients, presence or absence of the right superior...

4D FLOW: una nueva herramienta de diagnóstico para cardiopatías congénitas / 4D Flow MRI: a new diagnostic tool for congenital heart diseases

Purpose. To demonstrate the utility of 4D flow MR imaging for analyzing blood flow patterns and flow distribution in patients with congenital heart diseases. Methods: Six patients with congenital heart diseases were scanned using a standard cardiac MRI protocol, according to their condition. Additionally, 2D flow sequences of the great vessels, and a 4D flow sequence covering the entire heart were acquired. Flow patterns were visualized by using vector fields, streamlines and particle traces. Results: 4D flow technique depicted vortices and helical flow in the pulmonary artery of most patients, as well as in the aorta and superior vena cava of one patient with corrected aortic coarctation and a levoatrial cardinal vein. Conclusion: 4D flow MR imaging enables the identification of flow patterns difficult to detect with other diagnostic modalities. Comprehensive evaluation of flow patterns might help to understand the hemodynamic consequences of congenital heart diseases and their surgical procedures.

Objetivo. Demostrar la utilidad de 4D flow para el análisis de patrones y distribución de flujos en pacientes con cardiopatías congénitas. Métodos: Seis pacientes con cardiopatías congénitas fueron escaneados con un protocolo de resonancia magnética cardíaca estándar. Además se incluyeron secuencias de flujo 2D en los principales vasos del tórax y una secuencia 4D flow que cubría todo el corazón. Para la visualización de los patrones de flujo se emplearon vectores de velocidad, líneas de flujo y trazadores de partículas. Resultados: 4D flow reveló vórtices y hélices en la arteria pulmonar de la mayoría de los pacientes, y en la aorta y vena cava superior de un paciente con coartación aórtica reparada y vena cardinal levoatrial. Conclusiones: 4D flow permite identificar patrones de flujo en pacientes con cardiopatías congénitas, difíciles de observar con otros métodos diagnósticos. La evaluación de patrones de flujo podría contribuir a comprender las consecuencias hemodinámicas de diferentes cardiopatías congénitas.

Etiology and outcome of superior vena cava (SVC) obstruction in adults.

Between 1997 and 2002, 107 patients with symptoms of superior vena cava (SVC) obstruction presented at a university hospital in Northeast Thailand. Age averaged 50.7 years (range, 1 to 84). The male to female ratio was 5.7:1. Duration of symptoms before diagnosis was 29.4 days (range, 2 to 240), including facial swelling, cough, and chest discomfort. About 20% of cases developed respiratory failure and 11.2% died shortly after admission. The mean hospital stay was 23.7 days. Anteroposterior and lateral chest radiographs and computed chest tomography helped locate the lesion. Transbronchial biopsy through bronchoscopy, transthoracic needle biopsy under computed tomography, lymph node biopsy, pleural fluid cytology and/or biopsy were used for histopathologic sampling. High levels of alpha-fetoprotein and beta-HCG indicated an anterior mediastinal mass. The most common etiology of SVC obstruction was bronchogenic carcinoma (51.8%), followed by an anterior mediastinal mass (14.5%), lymphoma (13.6%--with an LDH of 262 to 1459 U/l), metastatic cancer (9.1%), and acute lymphoblastic leukemia (1.8%). Benign SVC thrombosis was found in four patients with Behcet's disease or some other idiopathy. Mediastinal fibrosis from melioidosis occurred in three patients, which is rare, has not been previouly reported. Most patients (63.6%) received a combination of radiotherapy and corticosteroid and this helped 55.2% improve.

Aspergillosis presenting as superior vena-caval obstruction: a case report

Aspergillosis is not an uncommon infection both in immunocompromized and immunocompetent patients 1 2. Despite it being more common in immunocompromized patients suffering from diseases like leukemia and other malignancies, systemic and pulmonary aspergillosis has been reported in immunocompetent patients also 3 4. Pulmonary aspergillosis often presents as respiratory infection unresponsive to antibiotics and diagnosed by isolation of fungus on culture of bronchial aspirates. We are reporting a case of ten year old girl having intrathoracic aspergillosis who presented with symptoms of superior vena caval obstruction

Persistencia de la vena cava superior izquierda: hallazgos escanográficos y significado clínico

Se presentan los hallazgos escanográficos de tres pacientes en quienes se documentó escanográficamente la persistencia anormal de la vena cava superior izquierda. Se revisa la embriología así como los hallazgos radiológicos y especialmente escanográficos en esta entidad, al igual que las implicaciones fisiopatológicas y clínicas de la misma. Se revisan los criterios diagnósticos en escanografía y los diagnósticos diferenciales.