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Incidence of persistent left superior vena cava in esophageal atresia
Nathan Mowery1, Deborah F Billmire, Marcus Schamberger
1JW Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Insights
Infants with esophageal atresia have a higher incidence of persistent left superior vena cava (PLSVC). This increased risk is not linked to other congenital anomalies, impacting central venous access in these children.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Cardiovascular System
Background:
- Esophageal atresia is frequently associated with congenital anomalies affecting multiple organ systems.
- Cardiovascular anomalies, particularly aortic arch and intrinsic cardiac malformations, are commonly noted.
- Persistent left superior vena cava (PLSVC) is the most prevalent thoracic venous anomaly, posing challenges for central venous access.
Purpose of the Study:
- To determine the incidence of PLSVC in infants diagnosed with esophageal atresia.
- To investigate whether specific subgroups of associated anomalies increase the risk of PLSVC in this population.
Main Methods:
- Retrospective review of pediatric patients treated for esophageal atresia between 1993 and 2002.
- Inclusion of 89 patients with sufficient data, analyzing gestational age, weight, atresia type, echocardiograms, and associated anomalies.
- Statistical analysis performed using Fisher's Exact test to compare incidences.
Main Results:
- A significantly higher incidence of PLSVC was observed in infants with esophageal atresia (9.9%) compared to the general population (0.3%).
- The presence of additional organ system anomalies did not significantly elevate the relative risk for PLSVC.
- No specific subgroup of associated anomalies was found to pose an additional risk for PLSVC.
Conclusions:
- The incidence of PLSVC is substantially elevated in infants with esophageal atresia.
- This increased PLSVC incidence is independent of other cardiac or associated anomalies.
- Awareness of this finding is crucial for managing central venous access in infants with esophageal atresia.
Purpose:
Esophageal atresia is known to be associated with a variety of additional congenital anomalies in multiple organ systems. Emphasis on cardiovascular anomalies has been focused on aortic arch and intrinsic cardiac malformations. Persistent left superior vena cava (PLSVC) is the most common venous thoracic anomaly in the general population and creates a problem when central venous access is required. This review was undertaken to define the incidence of PLSVC in infants with esophageal atresia and to determine if any subgroup of associated anomalies poses additional risk.
Methods:
A retrospective, institutional review board-approved review of all children treated for esophageal atresia from 1993 to 2002 at Riley Hospital for Children was undertaken. Of 118 children, 89 had sufficient data for inclusion. Charts were reviewed for gestational age, weight, type of atresia, echocardiogram, and associated anomalies. Statistical analysis was performed using the Fisher's Exact test.
Results:
Of 89 children, 8 (9.9%; confidence interval, 4%-17%) had PLSVC compared with the reported incidence of 0.3% in the general population. Presence of additional organ system anomalies did not significantly increase relative risk for PLSVC.
Conclusion:
The incidence of PLSVC is significantly increased in children with esophageal atresia when compared with the general population. This increased incidence of PLSVC is not influenced by the presence of cardiac or other associated anomalies. This finding should be kept in mind when central venous access is required in this patient population.
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