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Year : 2019  |  Volume : 12  |  Issue : 1  |  Page : 69-70
Vertical vein aneurysm in supracardiac total anomalous pulmonary venous connection


Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India

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Date of Web Publication14-Jan-2019
 

   Abstract 


Aneurysmal dilatation of the vertical vein in a case of supracardiac total anomalous pulmonary venous connection (TAPVC) is an extremely rare condition. It has been reported to occur secondary to severe compression of the vertical vein when it traverses between the left bronchus and the left pulmonary artery. We present a 14-year-old male with supracardiac TAPVC with a vertical vein aneurysm, probably secondary to stenosis caused by a thin membranous web just proximal to the aneurysm.

Keywords: Computed tomography angiography, supracardiac total anomalous pulmonary venous connection, vertical vein aneurysm

How to cite this article:
Pandey NN, Sharma A, Kumar S. Vertical vein aneurysm in supracardiac total anomalous pulmonary venous connection. Ann Pediatr Card 2019;12:69-70

How to cite this URL:
Pandey NN, Sharma A, Kumar S. Vertical vein aneurysm in supracardiac total anomalous pulmonary venous connection. Ann Pediatr Card [serial online] 2019 [cited 2019 Aug 21];12:69-70. Available from: http://www.annalspc.com/text.asp?2019/12/1/69/250141





   Clinical Summary Top


A 14-year-old male presented with symptoms of gradually progressive dyspnea on exertion and was observed to have mild cyanosis (patient's saturation on room air: 89%). A frontal chest radiograph revealed mild cardiomegaly with a large anterior mediastinal mass silhouetting the left upper paracardiac border [[Figure 1], panel a]. A subsequent transthoracic echocardiogram demonstrated supracardiac total anomalous pulmonary venous connection (TAPVC) with aneurysmal dilatation of the vertical vein along with a large ostium secundum atrial septal defect (ASD) and dilated right-sided cardiac chambers. The pulmonary artery systolic pressure, by tricuspid regurgitation, was 66 mmHg. The mean gradient across the vertical vein was 14 mmHg. The patient was further advised a computed tomography angiography (CTA) for accurate assessment of the cardiovascular anatomy and for planning surgical management.
Figure 1: (a) Frontal chest radiograph. (b) Maximum intensity projection images (coronal). (c and d) Sagittal oblique and coronal oblique images, respectively. (e and f) Volume rendered images. RSPV: Right superior pulmonary vein; RIPV: Right inferior pulmonary vein; LSPV: Left superior pulmonary vein; LIPV: Left Inferior pulmonary vein; VV: Vertical vein; LBCV: Left brachiocephalic vein; RIJV: Right internal jugular vein; LIJV: left internal jugular vein

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CTA showed all the four pulmonary veins draining into a common channel which was seen opening into an aneurysmally dilated segment of the vertical vein (indicated by *). This, in turn, drained into the left brachiocephalic vein and then into the superior vena cava [[Figure 1], panels b, e and f]. A thin membranous web was seen within the vertical vein, just proximal to the aneurysm, causing mild stenosis of the lumen at the same level [indicated by block arrows in [[Figure 1], panels c and d]. A large ostium secundum ASD was also seen along with dilated right atrium and right ventricle.


   Discussion Top


Aneurysmal dilatation of the vertical vein in a case of supracardiac TAPVC is an extremely rare condition. A previously reported case of vertical vein aneurysm attributed the formation of this aneurysm to poststenotic dilatation secondary to severe compression of the vertical vein when it traversed between the left bronchus and the left pulmonary artery.[1] This so-called “vascular vice” was not noted in our case. However, a thin membranous web was seen within the vertical vein, just proximal to the aneurysm, and causing luminal stenosis. A probable mechanism leading to the formation of aneurysm in our case could be an excessive poststenotic dilatation distal to the luminal stenosis caused by the membranous web in the vertical vein. To the best of our knowledge, this is the first ever reported case with vertical vein aneurysm in a case of supracardiac TAPVC associated with a membranous web in the vertical vein.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Phadke MS, Mate SD, Kerkar PG. Giant aneurysm of the vertical vein in a case of supracardiac total anomalous pulmonary venous connection. Cardiol Young 2016;26:968-70.  Back to cited text no. 1
    

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Correspondence Address:
Dr. Niraj Nirmal Pandey
Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/apc.APC_100_18

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