PROSPECTIVE ANGIOGRAPHIC STUDY OF THE ABNORMALITIES OF SYSTEMIC VENOUS CONNECTIONS IN CONGENITAL AND ACQUIRED HEART-DISEASE

Angiographic definition of systemic venous connections was obtained pr ospectively in 780 consecutive patients with congenital heart disease and 102 patients with acquired valvular heart disease undergoing cardi ac catheterization. Attempts were made to enter the innominate vein an d perform a balloon occlusion angiogram in each patient, In patients w ith congenital heart disease, bilateral superior vena cava were presen t in 32/771 patients (similar to 4%) with levocardia and 3/9 patients with dextrocardia, Among patients with bilateral superior vena cava (n =35), an innominate vein of variable size that could be entered was pr esent in six patients, Small tributaries connecting the right and left superior vena cava were found and entered in six patients, The superi or vena cava was entered via its connection to morphologic left atrium in five patients and via the coronary sinus in 17 patients, Abnormali ties of the inferior vena cava were seen in 7/780 patients, The follow ing abnormalities of the inferior vena cava were noted: azygous contin uation of rightsided inferior vena cava in levocardia-3 patients, hemi azygos continuation of the leftsided inferior vena cava in levocardia- 1 patient, azygos continuation of the leftsided inferior vena cava in dextrocardia-1 patient, interruption of inferior vena cava below the l iver with a plexus of veins joining the azygos vein-1 patient, and an inferior vena cava draining into the leftward aspect of the common atr ium-1 patient. Abnormalities of the systemic venous connections were s een in 2/102 patients with acquired heart disease: bilateral superior vena cava in 1 patient and bilateral inferior vena cava in 1 patient, Conclusions: Abnormalities of systemic venous connections were seen in similar to 5% patients with congenital heart disease and similar to 2 % patients with acquired heart disease, Small tributaries or an innomi nate vein of variable size often connect left and right superior vena. Contrast material can be injected into these connections to document the presence of bilateral superior vena cava, (C) 1996 Wiley-Liss, Inc .