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James C.s. Pollock - One of the best experts on this subject based on the ideXlab platform.
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Sinus Venosus defect: Single-patch repair with caval enlargement
The Annals of Thoracic Surgery, 1995Co-Authors: Vivek L. Pathi, Rafael Guererro, Kenneth Macarthur, M. P. G. Jamieson, James C.s. PollockAbstract:We present a single pericardial patch repair of the Sinus Venosus defect with anomalously connected pulmonary veins, incorporating enlargement of the superior vena cava. In our small series to date this procedure has been carried out without morbidity or mortality. Noninvasive follow-up by echocardiography and electrocardiography, over the short term, has not detected any stenosis of the venous pathways or Sinus node dysfunction.
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Transoesophageal echocardiographic assessment of primum, secundum and Sinus Venosus atrial septal defects.
International journal of cardiology, 1991Co-Authors: J P Gnanapragasam, M. P. G. Jamieson, A B Houston, D.b. Northridge, James C.s. PollockAbstract:We compared the ability of transthoracic and transoesophageal echocardiography to determine the presence and site of an atrial septal defect and associated anomalous pulmonary venous connexions in 13 school age children (aged 5 to 15 years) and 12 adults (aged 25 to 68 years). Transthoracic echocardiography detected atrial septal defects in 12 children and 6 adults. Transoesophageal echocardiography confirmed the position of 16 (13 secundum, 3 primum) of these 18 defects but altered the diagnosis from a secundum defect to a Sinus Venosus defect in one and from a Sinus Venosus defect to a high secundum defect in another. In addition to these 18, transoesophageal echocardiography diagnosed a defect in 5 adults (3 secundum and 2 Sinus Venosus defects) and 1 child (secundum defect). In an adult with inconclusive transthoracic findings, transoesophageal echocardiography enabled clear visualisation of the atrial septum and excluded an atrial septal defect. Transoesophageal echocardiography showed anomalous attachment of a pulmonary vein into the region of a Sinus Venosus defect (n = 3) but did not show anomalous connexions to the superior caval vein (n = 3) or the inferior caval vein (n = 1). Transoesophageal echocardiography provides a reliable method of diagnosing or excluding an atrial septal defect in patients with inconclusive transthoracic findings and is of particular diagnostic value in Sinus Venosus defects.
D.r. Walker - One of the best experts on this subject based on the ideXlab platform.
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Alternative technique for repair of Sinus Venosus atrial septal defect.
The Annals of thoracic surgery, 1991Co-Authors: J.r.l. Hamilton, S.g. Brooks, D.r. WalkerAbstract:A technique is described for closure of a Sinus Venosus atrial septal defect using a single patch held in place by sutures placed from outside the right atrium and underneath the superior vena cava. The superior vena cava does not require enlargement and potential damage to the artery to the sinoatrial node is avoided.
Robert H Anderson - One of the best experts on this subject based on the ideXlab platform.
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Understanding the spectrum of Sinus Venosus interatrial communications
Cardiology in the young, 2016Co-Authors: Justin T. Tretter, Diane E. Spicer, Robert H Anderson, Sathish M Chikkabyrappa, Carl L. Backer, Ralph S. Mosca, Puneet BhatlaAbstract:Background It is still thought by some that a common wall is to be found in the normal heart between the attachments of the caval and pulmonary veins, with absence of this wall underscoring the presence of Sinus Venosus defects. Recent findings using episcopic microscopy in developing mice have shown the deficiencies of this notion. Understanding that the superior rim of the oval fossa is a fold, rather than a true septum, which can be distorted in the presence of partially anomalous pulmonary venous drainage, has provided an alternative explanation for the morphogenesis of Sinus Venosus defects. Methods We reviewed our experience with patients suspected of having a Sinus Venosus defect from August, 2011, through October, 2015, analysing the findings in light of the current hypotheses used to explain the development of the defects, along with correlations made by inspection of autopsy specimens. Results We evaluated findings from 16 patients, with a mean age of 7.7 years, ranging from 2.7 to 15 years. Of the group, 13 were ultimately diagnosed with a superior Sinus Venosus defect, two with an inferior defect, and one with isolated anomalous pulmonary venous connection in the absence of an interatrial communication. Initially, two patients were thought to have oval fossa defects, one from each subtype, but were correctly diagnosed following cardiac magnetic resonance interrogation. Anomalous pulmonary venous connections were present in all cases. Conclusion Appreciation of the changes occurring during normal cardiac development helps in understanding the anatomical substrate underscoring the spectrum of Sinus Venosus defects. The lesions are veno-venous connections due to partially anomalous pulmonary venous connections, producing interatrial communications outside the confines of the interatrial septum.
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Veno-venous bridges: the forerunners of the Sinus Venosus defect.
Cardiology in The Young, 2011Co-Authors: Ryan J Butts, Anthony M. Hlavacek, Diane E. Spicer, Andrew C. Cook, Erwin Oechslin, Andrew M. Crean, Robert H AndersonAbstract:Differentiation of the so-called Sinus Venosus from other defects permitting shunting between the atrial chambers remains problematic. The earliest account of the entity, provided by Peacock,1 described how the hole permitting the interatrial communication was separated from the normal atrial septal structures. Hence, the lesions are not true septal defects. “Unroofing” of the right pulmonary veins was put forward to provide a mechanistic explanation for such holes, on the basis that a “party wall” normally separated these venous structures from the superior caval vein and the cavity of the right atrium.2 This explanation, however, flounders underneath the fact that, in the normal heart, the so-called “septum secundum” is an interatrial groove, rather than a true “party wall.”3 An alternative concept, therefore, is required to explain the existence of the Sinus Venosus defect. In a review of patients presenting with the inferior variant of the lesion, it was shown that the defining diagnostic feature is connection of a pulmonary vein to the inferior caval vein, but with the anomalous vein also retaining its connection with the left atrium.4 In this respect, Edwards and Helmholz5 had postulated long since that the lesion could be explained on the basis of persistence of connections existing in the developing foetus of communications between the pulmonary and systemic veins. Such a veno-venous fistula had been discovered at autopsy in an infant with discordant ventriculo-arterial connections, albeit not diagnosed during life.6 Others had also previously commented on the presence of extracardiac pulmonary-to-systemic venous channels that exist in the foetus.7 We have now encountered three adults with such systemic-to-pulmonary veno-venous communications that can explain the morphology of the superior Sinus Venosus defect. In this report, we discuss the diagnostic features of such communications, and show their relationship with the Sinus Venosus defects and with anomalous connection of the right upper pulmonary vein to the superior caval vein. We then provide supporting developmental and morphological evidence that the Sinus Venosus defect is a veno-venous malformation, rather than representing a problem with atrial septation. We report three patients diagnosed at either Medical University of South Carolina or Toronto General Hospital as having venous bridges between the superior caval vein and the right pulmonary veins. We compare the diagnostic features of these patients with those known to have isolated connection of the right upper pulmonary vein to the superior caval vein, anomalous systemic connection of the upper pulmonary veins with retention of connection of the lower pulmonary veins to the left atrium, and the Sinus Venosus defect, respectively. We then review our existing knowledge concerning the development of the pulmonary veins and the morphology of the superior Sinus Venosus defect.
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Inferior Sinus Venosus defect: Echocardiographic diagnosis and surgical approach
The Journal of thoracic and cardiovascular surgery, 2009Co-Authors: Matthew A. Crystal, Khaled Al Najashi, William G. Williams, Andrew N. Redington, Robert H AndersonAbstract:Objective We sought to define the inferior Sinus Venosus defect anatomically and document successful surgical approaches. Methods We identified all patients previously given a diagnosis of an inferior Sinus Venosus defect at the Hospital for Sick Children, Toronto, Canada, between 1982 and 2005 by interrogating the cardiology and cardiac surgery databases. We included those having interatrial communications in which 1 or more of the right pulmonary veins drained to the inferior caval vein but retained connection with the left atrium, the rims of the oval fossa, and the walls of the coronary Sinus, both being intact. Results We identified 11 children who had an interatrial communication meeting the criteria for and undergoing surgical repair of an inferior Sinus Venosus defect. Median age was 1.2 years; 6 (55%) subjects were male, and none were cyanotic. Transthoracic echocardiographic analysis was performed preoperatively in all children, revealing right ventricular dilation in all. Surgical repair was accomplished with a pericardial patch. A complex baffle was needed in 3 children to maintain unobstructed inferior caval and pulmonary venous return. The echocardiographic diagnosis was complete in only 5 patients, but all diagnoses were correct since the year 2000. In all children the observations at surgical intervention showed that the defect was a venoatrial communication involving drainage of the right pulmonary veins to the inferior caval vein while retaining connection to the left atrium. Conclusions Transthoracic echocardiographic analysis should remain the modality of choice for diagnosis of the inferior Sinus Venosus defect. We report excellent surgical results with a patch or baffle, correctly redirecting the anomalous venoatrial connections.
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The nature of the superior Sinus Venosus defect
Clinical anatomy (New York N.Y.), 1998Co-Authors: Ahmed M. Al Zaghal, Robert H AndersonAbstract:The location, and morphology, of the superior Sinus Venosus interatrial communication remains contentious. As part of a clinical study, we examined anatomic specimens and echocardiograms so as to clarify the arrangement of the normal atrial septal structures, and compared them with the arrangement found in the superior Sinus Venosus defect. The pathognomonic diagnostic criterion in the abnormal hearts was overriding of the intact muscular rim of the oval fossa by the mouth of the superior caval vein. This muscular rim is, in reality, a tube of myocardium which encloses a core of extracardiac adipose tissue. Understanding of this anatomic conundrum clarifies the understanding of the structures of both the normal atrial septum and Sinus Venosus defects.
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Anatomical criteria for the diagnosis of Sinus Venosus defects.
Heart (British Cardiac Society), 1997Co-Authors: Ahmed M. Al Zaghal, Robert H Anderson, Christopher Lincoln, Darryl F. Shore, Michael L. RigbyAbstract:BACKGROUND: The diagnosis of Sinus Venosus defects remains a matter of debate. It is crucial to provide solid anatomical criteria, by identifying the very nature of the atrial septum relative to Sinus Venosus defects, to diagnose and differentiate them from other interatrial communications. OBJECTIVE: This study was designed to reestablish the anatomical criteria for the diagnosis of Sinus Venosus defects. METHODS: Five specimens with Sinus Venosus defects from the cardiopathological museum were examined. Study of the abnormal hearts was supplemented by examining the extent and structure of the atrial septum in 10 normal hearts. The echocardiograms and surgical notes were reviewed from 18 patients seen between July 1991 and August 1996 at the Royal Brompton Hospital in London diagnosed preoperatively to have a Sinus Venosus defect. RESULTS: The nature of the oval fossa and its muscular borders were identified in the normal hearts. In all three autopsied specimens of the superior variety of Sinus Venosus defect, the mouth of the superior caval vein was overriding the intact muscular anterosuperior border of the oval fossa. Two specimens thought initially to have the inferior variety of Sinus Venosus defect were re-classified as having defects within the oval fossa as it was the deficient oval fossa itself, rather than its intact muscular border, that was overridden by the mouth of the inferior caval vein. Sixteen patients had been diagnosed echocardiographically as exhibiting the superior variant of the defect. Retrospective review showed overriding of the superior caval vein across the upper rim of the oval fossa in 12 patients. These findings were confirmed by surgery in 11 patients with the 12th awaiting operation. Overriding of the fossa by the caval vein was not found in the other four patients. Surgery in all of these showed the defect to be within the oval fossa. In two patients diagnosed echocardiographically as having inferior defects, the surgical findings confirmed a biatrial connection of the inferior caval vein in one patient, the findings in the second were equivocal. CONCLUSIONS: The key anatomical criterion for the diagnosis of Sinus Venosus defects is overriding of the mouth of the superior or inferior caval vein across the intact muscular border of the oval fossa. The interatrial communication is then formed within the mouth of the overriding vein, and is outside the confines of the oval fossa.
Elie Mousseaux - One of the best experts on this subject based on the ideXlab platform.
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Stroke after surgical treatment of Sinus Venosus type atrial septal defect: percutaneous treatment
International journal of cardiology, 2007Co-Authors: Gabriella Agnoletti, Laurence Iserin, Younes Boudjemline, Elie MousseauxAbstract:Abstract Background and purpose Sinus Venosus-type atrial septal defect can be associated with anomalous drainage of the upper right pulmonary vein into the superior vena cava. Surgical correction provides reconstruction of superior vena cava and rerouting of the pulmonary vein into the left atrium. Summary of case We report the case of a young woman who experienced 2 strokes 11 years after surgical repair of Sinus Venosus-type atrial septal defect. Conclusions Interventional treatment resolved the superior vena cava stenosis, rerouted the pulmonary vein into the left atrium and abolished the right to left shunt.
M. P. G. Jamieson - One of the best experts on this subject based on the ideXlab platform.
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Sinus Venosus defect: Single-patch repair with caval enlargement
The Annals of Thoracic Surgery, 1995Co-Authors: Vivek L. Pathi, Rafael Guererro, Kenneth Macarthur, M. P. G. Jamieson, James C.s. PollockAbstract:We present a single pericardial patch repair of the Sinus Venosus defect with anomalously connected pulmonary veins, incorporating enlargement of the superior vena cava. In our small series to date this procedure has been carried out without morbidity or mortality. Noninvasive follow-up by echocardiography and electrocardiography, over the short term, has not detected any stenosis of the venous pathways or Sinus node dysfunction.
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Transoesophageal echocardiographic assessment of primum, secundum and Sinus Venosus atrial septal defects.
International journal of cardiology, 1991Co-Authors: J P Gnanapragasam, M. P. G. Jamieson, A B Houston, D.b. Northridge, James C.s. PollockAbstract:We compared the ability of transthoracic and transoesophageal echocardiography to determine the presence and site of an atrial septal defect and associated anomalous pulmonary venous connexions in 13 school age children (aged 5 to 15 years) and 12 adults (aged 25 to 68 years). Transthoracic echocardiography detected atrial septal defects in 12 children and 6 adults. Transoesophageal echocardiography confirmed the position of 16 (13 secundum, 3 primum) of these 18 defects but altered the diagnosis from a secundum defect to a Sinus Venosus defect in one and from a Sinus Venosus defect to a high secundum defect in another. In addition to these 18, transoesophageal echocardiography diagnosed a defect in 5 adults (3 secundum and 2 Sinus Venosus defects) and 1 child (secundum defect). In an adult with inconclusive transthoracic findings, transoesophageal echocardiography enabled clear visualisation of the atrial septum and excluded an atrial septal defect. Transoesophageal echocardiography showed anomalous attachment of a pulmonary vein into the region of a Sinus Venosus defect (n = 3) but did not show anomalous connexions to the superior caval vein (n = 3) or the inferior caval vein (n = 1). Transoesophageal echocardiography provides a reliable method of diagnosing or excluding an atrial septal defect in patients with inconclusive transthoracic findings and is of particular diagnostic value in Sinus Venosus defects.