Methodist Journal

IN THIS ISSUE

Lipids and Lipoproteins

Vol 15, Issue 1 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

Lipids and Cardiovascular Disease: Putting it All Together

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RECOGNITIONS

Guest Editors Henry Pownall and Antonio Gotto Offer Insight and Expertise on the topic of Lipids and Cardiovascular Disease

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REVIEW ARTICLES See More

Cholesterol: Can’t Live With It, Can’t Live Without It

How Much Do Lipid Guidelines Help the Clinician? Reading Between the (Guide)lines

Statins: Then and Now

Poststatin Lipid Therapeutics: A Review

HDL and Reverse Cholesterol Transport Biomarkers

Revisiting Reverse Cholesterol Transport in the Context of High-Density Lipoprotein Free Cholesterol Bioavailability

High-Density Lipoprotein Subspecies in Health and Human Disease: Focus on Type 2 Diabetes

Gene Delivery in Lipid Research and Therapies

CASE REPORTS See More

Device-Related Thrombus: A Reason for Concern?

Retained Coronary Balloon Requiring Emergent Open Surgical Retrieval: An Uncommon Complication Requiring Individualized Management Strategies

Loperamide Mimicking Brugada Pattern

Reversed Pulsus Paradoxus in Right Ventricular Failure

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Transcatheter Embolization of a Persistent Vertical Vein: A Rare Cause of Left-to-Right Shunt and Right-Sided Heart Failure

CLINICAL PERSPECTIVES See More

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

Addressing the Feedback Loop Between Depression, Diabetes, and Cardiovascular Disease

POINTS TO REMEMBER

The Kidney as an Endocrine Organ

EDITORIALS

Addressing the Underrepresentation of Women in Cardiology through Tangible Opportunities for Mentorship and Leadership

Vol 15, Issue 1 (2019)

Article Full Text

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER

Transcatheter Embolization of a Persistent Vertical Vein: A Rare Cause of Left-to-Right Shunt and Right-Sided Heart Failure

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Article Citation:

Fuentes Rojas SC, Thakkar A, Chinnadurai P, Karanja E, Bawa D, Monteiro G, MacGillivray T, Breinholt JP, Lin CH. Transcatheter Embolization of a Persistent Vertical Vein: A Rare Cause of Left-to-Right Shunt and Right-Sided Heart Failure. Methodist DeBakey Cardiovasc J. 2019;15(1):86-7.



Keywords
vertical vein , transcatheter embolization

A 30-year-old woman with a history of neonatal repair of infracardiac obstructed total anomalous pulmonary venous return (TAPVR) presented with dyspnea on exertion. Cardiac magnetic resonance imaging and computed tomography performed at presentation showed an anomalous connection—an unligated vertical vein—between the pulmonary venous confluence and portal venous system (Figure 1 A, B). The right ventricle was enlarged with depressed function. Transseptal catheterization was performed, and left lower pulmonary venography showed opacification of the confluence with return into the left atrium and into the portal vein through the vertical vein. An Agilis steerable sheath (Abbott Vascular) permitted optimal cannulation of the vertical vein, which measured 16.6 x 14 mm (Figure 1 C). A 22-mm AMPLATZER Vascular Plug II (Abbott Vascular) was deployed through a 7-Fr Pinnacle Destination sheath (Terumo Medical) (Figure 1 D). After deployment, there was no pressure gradient between the left lower pulmonary vein and the left atrium. The patient reported improved exercise tolerance during follow-up.

In TAPVR, the anomalous pulmonary veins return to a venous confluence, which then returns to the systemic venous circulation via a single “vertical vein.”  In some cases, the vertical vein drains into the hepatic venous circulation, thus creating a left-to-right shunt that leads to right-sided volume overload. Some operators favor leaving the vertical vein unligated, particularly in obstructed TAPVR, while most favor ligation to remove the source of left-to-right shunt.1,2 This case depicts the successful transcatheter embolization of a persistent vertical vein.

Conflict of Interest Disclosure

Dr. Chinnadurai is a full-time senior staff scientist at Siemens Healthcare, USA. Dr. Lin is a data monitoring committee member of ACI Clinical and speaker for Abiomed.

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