Superior vena cava là gì

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Revista Española de Cardiología is an international scientific journal devoted to the publication of retìm kiếm articles on cardiovascular medicine. The journal, published since 1947, is the official publication of the Spanish Society of Cardiology và founder of the REC Publications journal family. Articles are published in both English & Spanish in its electronic edition.


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To the Editor,

We present the case of a 73-year-old man with a peripheral access central catheter (Drum), from the left upper extremity, for total parenteral administration of nutrition due to digestive sầu problems. By chance, upper slices of a contrast abdominal computerized tomography (CT) study revealed what could be described as “left atrial mass” (Figure 1). Transthoracic echocardiography showed a highly dilated coronary sinus occupied by abundant echogenic material of possibly thrombotic origin (Figure 2). Given these findings, we checked the central catheter placement & in the control X-ray following Drum deployment found that it followed a trajectory through the left superior vemãng cầu cava.


Figure 1. Contrast thoracoabdominal computerized tomography. lưu ý the presence of a defect in repletion cđại bại khổng lồ the left atrium (arrows) although the first images following contrast injection (left) show the defect is really located in a vascular structure posterior-lateral lớn the atrium (compatible with left superior vemãng cầu cava và its continuation in the coronary sinus).

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Figure 2. Transthoracic echocardiography. A: detail of the long parasternal axis; note a highly dilated coronary sinus protruding towards the left atrium with echolucent content. B: apical 4-chamber plane, modified with posterior projection to lớn include coronary sinus drainage (*) into lớn the right atrium; note the presence of thrombotic material in the coronary sinus (arrow). LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle.

Transesophageal echocardiography was used khổng lồ clarify the diagnosis & confirmed catheter placement was in the left superior vemãng cầu cava, with abundant thrombotic material located between the catheter tip & coronary sinus. Agitated saline solution injected through the catheter could also have sầu helped complete the diagnosis. However, we chose lớn avoid this maneuver given we might have sầu dislodged emboli during the infusion.

Despite these findings, the catheter remained permeable và we observed no thrombosis-derived symptoms. The patient was administered anticoagulation therapy (initially with sodium heparin & later with oral anticoagulants). The first control echocardiogram (at 1 week) revealed the continued presence of thrombus. We therefore decided khổng lồ withdraw the catheter, without initial resolution of the clot. However, 2 weeks later we found it had disappeared.

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Persistent left superior vemãng cầu cava is a relatively frequent anatomic variable of central venous drainage (1% in the general population). It is often found during central catheter placement or when using imaging techniques.1 Catheter placement using this access is not contraindicated and pacemaker electrode deployment via this route has been described elsewhere.2 However, both in central catheter placement & pacemaker electrode deployment, control X-ray projections must be studied to lớn exclude anomalous trajectories. In selected cases, echocardiography is useful in clarifying catheter location with respect to lớn cardiac structures.3

We have sầu found no other cases of catheter thrombosis in the left superior vemãng cầu cava in the literature. Hence, we consulted general guidelines on deep vein thrombosis lớn decide what action to take. Guidelines include catheter withdrawal, anticoagulation therapy or fibrinolysis4 &, occasionally, thrombectomy by aspiration,5 or surgical withdrawal of the clot.6 Several studies discuss the hypothetical chance that fibrinolysis và catheter withdrawal might help dislodge fragments of thrombotic material, although results of series reported show catheter withdrawal can be performed safely.4 In our patient, given good clinical tolerance & the large amount of thrombotic material, we initially decided against manipulating the catheter. However, faced with no initial improvement, we finally opted for withdrawal, which gave sầu rise to lớn no complications và enabled us lớn resolve sầu the patient's condition.