Biatrial or left atrial drainage of the right superior vena cava: anatomic, morphogenetic, and surgical considerations--report of three new cases and literature review.

Since the posterior wall of the right superior vena cava (RSVC) is contiguous with the anterior wall of the right upper pulmonary veins, a localized defect in this common wall may create a cavopulmonary venous confluence without eliminating the normal connection of the same right pulmonary veins with the left atrium (LA). Through this defect, blood of the unroofed right pulmonary veins will drain into the RSVC and right atrium (RA), and blood from the RSVC may shunt into the right pulmonary veins and LA. Hemodynamically, the RSVC will become biatrial. If the RSVC blood flows preferentially into the LA, its right atrial orifice will become stenotic or even atretic. If atretic, the normally positioned RSVC will drain entirely into the LA. In this report, we present the clinical and anatomical findings of two postmortem cases with biatrial drainage of the RSVC. We also document the clinical, echocardiographic, angiocardiographic, and surgical data of a living patient with left atrial drainage of the RSVC and tetralogy of Fallot with pulmonary atresia. The relevant literature and surgical treatment are reviewed, and the morphogenesis of the biatrial and left atrial RSVC is considered.

Use of platinum microcoils to embolize vascular abnormalities in children with congenital heart disease.

Many vascular anomalies found in children with congenital heart disease can be embolized with catheter-delivered steel coils. Platinum microcoils delivered through a microcatheter broaden the spectrum of lesions amenable to transcatheter closure. Platinum microcoil delivery technique is described, and representative cases demonstrating microcoil utility and benefits are presented.

Use of Palmaz stents to palliate pulmonary atresia with ventricular septal defect and stenotic aortopulmonary collaterals.

A 29-year-old woman with pulmonary atresia and ventricular septal defect underwent palliative stenting of a stenotic aortopulmonary collateral. Follow-up demonstrated patent stents, with improved oxygenation and exercise capacity. This approach offers an attractive alternative to surgical shunt placement in select patients.

Management of azygos vein "steal" following hemi-Fontan by transcatheter coil embolization.

An 11-mo-old girl developed cyanosis following hemi-Fontan for hypoplastic left heart syndrome. Azygos vein "steal" was diagnosed at catheterization and successfully treated by transcatheter coil embolization. Clinical improvement was seen immediately and at 5-mo follow-up.