Methodist Journal

IN THIS ISSUE

Adult Congenital Heart Update

Vol 15, Issue 2 (2019)


FEATURED GUEST EDITOR

ISSUE INTRO

The Growing Number of Adults Surviving with Congenital Heart Disease

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RECOGNITIONS

Drs. MacGillivray and Lin Take the Lead in Adult Congenital Heart Disease

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REVIEW ARTICLES See More

Advanced Cardiac Imaging for Complex Adult Congenital Heart Diseases

149 Fontan Conversions

Anomalous Aortic Origin of a Coronary Artery

Pulmonary Valve Replacement for Tetralogy of Fallot

Management of the Adult with Arterial Switch

Ebstein’s Anomaly

Heart Transplantation in Adults with Congenital Heart Disease

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

CASE REPORTS See More

Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve

Uneventful Follow-Up 2 Years after Endovascular Treatment of a High Flow Iatrogenic Aortocaval Fistula Causing Pulmonary Hypertension and Right Heart Failure

Device-Related Thrombus: A Reason for Concern?

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

MUSEUM OF HMH MULTIMODALITY IMAGING CENTER See More

Do I Look Fat in This? Multimodality Imaging Findings of a Cardiac Lipoma

CLINICAL PERSPECTIVES See More

POINTS TO REMEMBER

The Kidney in Congenital Cyanotic Heart Disease

EXCERPTA

Talking Statins with Antonio Gotto

POINTS TO REMEMBER

Lipids and Renal Disease

EXCERPTA

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

EDITORIALS

Letter to the Editor in Response to “Cardiac Autonomic Neuropathy in Diabetes Mellitus”

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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