Revista Española de Cardiología (English Edition) Revista Española de Cardiología (English Edition)
Rev Esp Cardiol. 2016;69:1098 - Vol. 69 Num.11 DOI: 10.1016/j.rec.2016.03.003

Isolated Anomaly of the Systemic Venous Return

Miguel Antonio López-Garrido a, Begoña Igual-Muñoz b, Alicia M. Maceira b,

a Unidad de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain
b Unidad de Imagen Cardiovascular, ERESA Centro Médico, Valencia, Spain

Article

A 17-year-old woman with no relevant medical history was referred to our cardiology unit due to atypical chest discomfort. After echocardiographic observation of dilatation of the coronary sinus, cardiac magnetic resonance imaging performed to complete the study revealed absence of the right inferior vena cava (VC), direct drainage of the suprahepatic veins into the right atrium, and a blood vessel to the left of the abdominal aorta (left inferior VC) that continued through the chest along the hemiazygos veins (Figure 1). A sagittal cine sequence showed that this vessel ran upward, parallel and to the left of the aorta (Figure 2), and flowed to the right cardiac chambers, as shown on the phase-contrast sequence (Figure 2). Three-dimensional volume-rendered magnetic resonance angiography revealed the absence of the right superior VC and a persistent left superior VC that communicated with the hemiazygos, forming a common collector that emptied into the coronary sinus (Figure 2). The cardiac magnetic resonance imaging also allowed us to rule out the presence of intracardiac shunts or associated complications.

Figure 1.

Figure 2.

A persistent left superior VC is the most frequent systemic venous anomaly and should be suspected upon detection of a dilated coronary sinus. The association of this persistent vein with this type of congenital abnormality of the inferior VC is very rare, and it can sometimes be associated with septal defects or heterotaxy syndromes.

Although infrequent, this anomaly can have complications, such as ureteral compression or compression of the inferior VC between the mesenteric artery and the aorta (nutcracker syndrome), which increases the risk of deep vein thrombosis.

Corresponding author: amaceira@eresa.com

1885-5857/© 2016 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved

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