systemic venous return anomalies

1. Anomalies of the systemic
venous return
Dr. Anup kumar Sarkar
MS (CVTS) final part student
NHFH&RI

2.  A wide variety of abnormalities appears in the systemic venous
system; some of these have little physiologic importance and
others produce cyanosis.
 Some of these anomalies produce difficulties during surgery and
preoperative knowledge is important.
 Anomalies of systemic venous return are frequently associated
with other congenital cardiac defects and with atrial isomerism.

3. Embryology
• In the 5th week of development, three
pairs of major veins can be
distinguished
The cardinal veins: draining blood of
embryo proper.
The vitelline veins (omphalomesenteric
vein): carrying blood from yolk sac to
sinus venosus
The umbilical vein: originating in
chronic villi, carrying oxygenated blood
to embryo.

4. The cardinal system forms the caval system.
The vitelline system develops into the portal system.
The umbilical system disappears after birth.

5. During the fifth to the seventh
weeks, a number of additional veins
are formed:
 The subcardinal veins- mainly
drain the kidneys
The sacrocardinal veins- drain the
lower extremities.
The supracardinal veins- drain the
body wall by way of the intercostal
veins.

6. Anomalies of the superior vena cava
Persistent left SVC draining into RA
• Result from failure of the left
anterior and left common cardinal
vein to involute.
• Does not produce any functional
significance

7. Diagnosis
Chest radiography films may
show the shadow of the left SVC
along the upper left border of
mediastinum

8. Diagnosis
2D echocardiography-100%
specificity and 96% sensitivity
Enlarged coronary sinus is often
the first clue to diagnosis of
PLSVC

9. Surgical importance
-Techniques of venous cannulation
-Route of administration of cardioplegia
-Intra-cardiac repair of associated anomalies in specific
surgical situations

10. Persistent LSVC draining into left atrium
Rarely PLSVC drains into the LA,
resulting in systemic arterial
desaturation.
Associated cardiac anomalies are almost
invariably present.
Echo study with colour flow mapping
usually provide adequate diagnosis.

11. Treatment
• Surgical correction is necessary.
• If there is an adequate-size bridging vein that connects two SVCs,
simple ligation of the LSVC is performed.
• If the right SVC is absent or a bridging vein is inadequate, the LSVC
is transposed to the RA.

12. Anomalies of Inferior Vena Cava
Significant anomalies are:
Interrupted IVC with Azygous continuation
IVC connecting to the left atrium
Bilateral Inferior Vena Cava

13. Interrupted IVC with azygous continuation
The IVC is made up of four segments during
the embryonic period, and failure of the
formation of hepatic segment results in an
interrupted IVC
Frequently associated with complex
congenital heart disease.
Hepatic veins continue to drain into right
atrium as a single trunk or as separate vessels.

14. Interrupted IVC with azygous continuation
This anomaly does not result in clinical manifestations.
Can be readily diagnosed by echocardiography.
No specific treatment is indicated.
Surgical importance during venous cannulation.

15. Coronary sinus anomalies
Coronary sinus defect and unroofed CS
Coronary sinus orifice atresia
Coronary sinus aneurysm or diverticulum

16. Coronary sinus defect and unroofed CS
Unroofed coronary sinus almost
always is associated with PLSVC
A CS defect without an
associated LSVC, the physiology
is the same as in ASD.
Diagnosis by Echocardiography
Surgery is performed for
associated malformations

17. Take Home Message
A wide variety of abnormalities appears in the systemic venous
system and frequently associated with others cardiac anomalies.
Persistent LSVC is most common anomaly of SVC and PLSVC can drain
either in RA or LA.
Interrupted IVC with azygous continuation is most common anomaly
of IVC.
Systemic venous anomalies have surgical importance during venous
cannulation, intra-cardiac repair and cardioplegia delivery; hence
preoperative diagnosis is important.