Anomalies of the systemic venous return

Area of Science:

• Cardiovascular Medicine
• Pediatric Cardiology
• Medical Imaging

Background:

• Anomalies in systemic venous development, especially the inferior vena cava (IVC), pose significant challenges for cardiac catheterization and surgical interventions.
• These venous anomalies can complicate diagnostic and therapeutic procedures, impacting patient outcomes.

Purpose of the Study:

• To investigate the prevalence and types of systemic venous anomalies in children undergoing cardiac catheterization and angiocardiography.
• To determine the association between IVC anomalies, visceral situs indeterminatus, and congenital heart disease.

Main Methods:

• Retrospective analysis of 1,266 pediatric patients who underwent cardiac catheterization and angiocardiography.
• Detailed examination of venous anatomy, including superior vena cava (SVC) and IVC anomalies.
• Correlation of venous anomalies with visceral situs and congenital heart defects.

Main Results:

• Systemic venous anomalies were identified in 2.5% (32/1,266) of the pediatric cohort.
• IVC anomalies were observed in 27 children, including persistent paired IVC, aplasia with azygos/hemiazygos continuation, and IVC at the cardiac apex.
• Severe SVC anomalies occurred in six children, with one also having an IVC anomaly.
• Visceral situs indeterminatus and severe congenital heart disease (e.g., transposition of great arteries, pulmonary stenosis/atresia) were associated with IVC anomalies in 19 children.

Conclusions:

• Systemic venous anomalies, particularly IVC anomalies, are present in a notable percentage of children undergoing cardiac procedures.
• The combination of IVC anomalies, visceral situs indeterminatus, and congenital heart disease is significant and can be suspected on chest films, but definitively diagnosed via angiocardiography.