This is a case report of the prophylactically placed titanium Greenfield vena cava filter to prevent development of pulmonary thromboembolism for the surgical removal of huge leiomyoma uteri associated with deep vein thrombosis. The patient is a 39 year old female who suffered from swelling and pain in both lower extremities for 5 days. She has realized a huge mass in her pelvic cavity and abdomen since 3 years ago and has felt it growing since 1 year ago. CT discloses a heterogeneously enhanced huge mass containing cystic changes and secondary thrombosis in L iliac and L femoral veins due to compression by the mass. Deep vein thrombosis is detected in ascending venogram of the L leg. A titanium Greenfield vena cava filter was placed with transjugular approach in infrarenal portion of the inferior vena cava. After that the mass was surgically removed. No pulmonary symptom concerning pulmonary thromboembolism has developed following the surgery, but swelling and pain have developed in R leg. Follow-up CT shows new diffuse thrombosis in lower inferior vena cava and R iliac veins below the filter inferiorly, extending to R leg. Antithrombotic treatment was started with heparin and Coumadin.
Abdomen ; Adult ; Female ; Femoral Vein ; Follow-Up Studies ; Heparin ; Humans ; Iliac Vein ; Leg ; Leiomyoma ; Lower Extremity ; Pulmonary Embolism ; Thrombosis ; Titanium ; Uterus ; Vena Cava Filters ; Vena Cava, Inferior ; Venae Cavae ; Venous Thrombosis ; Warfarin

To understand the local fluid dynamics for different designs of Fontan operation, five models were made of Pyrex glass to facilitate in vitro study. Models I, II and III had the same position as the center of the anastomosis of the IVC (inferior vena cava) with that of the SVC (superior vena cava), but Models IV and V had 10 mm offset between them. As well, the anastomotic junction angles were different (Models I and IV: 90 degrees, Models II and V: 70 degrees, Model III: 45 degrees). These models were then connected to a flow loop for flow visualization study. In Model I, no dominant vortex was seen in the central region of the junction, but a large unstable vortex was created in Models II and III. In Models IV and V, a significant stagnation region was created in the middle of the offset region. It also showed that the flow distribution from the IVC and SVC to the LPA (left pulmonary artery) and RPA (right pulmonary artery) depends more on the offset of the junction than on the anastomotic junction angle. Generally, as the total flow rates increased, the pressures in the models increased.
Blood Pressure ; Hemodynamics ; Human ; Models, Cardiovascular* ; Regional Blood Flow ; Gov't Venae Cavae/physiology*

The diagnosis,surgical treatment,and comprehensive treatment of renal cell carcinoma with inferior vena cava tumor thrombus have advanced rapidly in recent years. Both the survival and quality of life of the patients have remarkably improved. Further advance in basic research may provide new direction of management of renal cell carcinoma.
Carcinoma, Renal Cell ; complications ; diagnosis ; therapy ; Embolism ; diagnosis ; etiology ; therapy ; Humans ; Kidney Neoplasms ; complications ; diagnosis ; therapy ; Venae Cavae

Carval syndrome is a severe heartworm infection where the worms have migrated to the right atrium and vena cava; this condition is associated with a myriad of clinical signs. Several non-surgical and interventional methods are currently used for mechanical worm removal. However, the success rate and complications related to these methods are heavily dependent on methodology and retrieval devices used. In this study, we developed a catheter-guided heartworm removal method using a retrieval basket that can easily access pulmonary arteries and increase the number of worms removed per procedure. With this technique, we successfully treated four dogs with caval syndrome.
Animals ; Dirofilaria immitis/*growth & development ; Dirofilariasis/*parasitology/*surgery ; Dog Diseases/*parasitology/*surgery ; Dogs ; Female ; Heart Atria/parasitology/surgery ; Heart Catheterization/instrumentation/methods/*veterinary ; Male ; Venae Cavae/parasitology/surgery

Anesthesia, General ; Animals ; Central Venous Pressure ; physiology ; Heart Function Tests ; Hemodynamics ; physiology ; Respiration, Artificial ; Shock, Septic ; pathology ; Swine ; physiology ; Venae Cavae ; physiology

OBJECTIVETo review the experience of staged total cavopulmonary connection (TCPC) in complex congenital heart diseases.

METHODSFrom June 1998 to March 2008, 22 patients underwent staged TCPC for complex congenital heart diseases. Among them, 9 were univentricular and pulmonary artery valve stenosis; 3 were univentricular and pulmonary artery atresia; 1 was transposition of great arteries, crisscross heart and pulmonary artery valve stenosis; 1 was complete atrioventricular canal defects, left ventricular hypoplasia, pulmonary artery atresia and atrioventricular valvular regurgitation; 1 was complete atrioventricular canal defects, left ventricular hypoplasia, pulmonary artery valve stenosis and atrioventricular valvular regurgitation after Glenn procedure; 1 was mirror image dextrocardia, single ventricle, pulmonary artery atresia, major aortopulmonary collateral arteries (MAPCAs) and right pulmonary arteriovenous fistula after Glenn procedure; 4 were tricuspid atresia and pulmonary artery valve stenosis; 1 was tricuspid atresia and pulmonary atresia; 1 was mirror image dextrocardia, double-outlet of right ventricle, left ventricular hypoplasia, pulmonary artery valve stenosis, tricuspid incompetence, and MAPCAs. Among them, 5 patients received systemic-to-pulmonary artery shunt, bidirectional Glenn procedure and TCPC. Seventeen patients received bidirectional Glenn procedure, the mean age was (5.9+/-4.4) years old. Pulmonary artery pressure pre-Glenn procedure was 17 to 20 mm Hg (1 mm Hg=0.133 kPa). Atrioventricular valve incompetence in 3 patients. Nakata index was less than 200 mm2/m2 in 4 patients before the first stage operation. The age of TCPC procedure was (9.6+/-4.9) years old, the interval time was (3.7+/-1.2) years.

RESULTSThere was one in-hospital death, the mortality was 4.5%. The patient with univentricular and pulmonary atresia, received systemic-to-pulmonary artery shunt, bidirectional Glenn procedure and TCPC and died of pneumorrhagia. Other patients were recovered well, postoperative central venous pressure was 12 to 18 mm Hg, percutaneous oxygen saturation was 90% to 96%. The cardiac function were in NYHA class I to II.

CONCLUSIONSThe staged TCPC was a good procedure in high-risk Fontan candidates. The results were satisfactory for those patients. This staged strategy may extend the operative indications for the Fontan procedure.

Adolescent ; Anastomosis, Surgical ; methods ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Heart Bypass, Right ; methods ; Heart Defects, Congenital ; surgery ; Humans ; Male ; Pulmonary Artery ; surgery ; Retrospective Studies ; Treatment Outcome ; Venae Cavae ; surgery ; Young Adult

To get insights into the principles of gene expression changes during cardiac hypertrophy, three rat cardiac hypertrophy models were prepared, i.e., suprarenal abdominal aortic stenosis (SRS), arterial-vein fistula (AVF) and continuous jugular vein infusion of norepinephrine (NEi). The cardiac function and structure were analyzed by echocardiograph as well as histological examination. Total RNA of left ventricles was extracted and gene expression profiles were analyzed by cDNA microarray. SRS and NEi induced concentric cardiac hypertrophy and AVF induced eccentric hypertrophy in rats, among which NEi caused obvious cardiac fibrosis. The changes of gene expression profiles were compared comprehensively across different pathologic cardiac hypertrophy models. While gene expression profiles of different cardiac hypertrophy models compared with pairs, parts of the genes involved were found overlapped, and mostly the gene expression changed in the same direction between two models, but some of them changed in the opposite directions. Expression levels of 19 genes were found changed across all cardiac hypertrophy models, and genes relatively regulated in a specific model was also found when comparison of all the three models was carried out. Novel clues for further study might derive from the results mentioned above, and some genes might be the marker genes of cardiac hypertrophy or the targets of therapy.
Animals ; Aorta, Abdominal ; surgery ; Arteriovenous Shunt, Surgical ; Cardiomegaly ; etiology ; genetics ; Constriction ; Gene Expression Profiling ; Male ; Myocytes, Cardiac ; drug effects ; metabolism ; Norepinephrine ; Oligonucleotide Array Sequence Analysis ; Oligonucleotide Probes ; Random Allocation ; Rats ; Rats, Wistar ; Venae Cavae ; surgery

In patients with superior vena cava syndrome, the form of the collateral circulatory system whichcommuni-cates with the inferior vena cava via various systemic veins usually varics. We found an instance ofunusual collateral circulation : direct communication between the systemic and pulmonary vein in a woman withsuperior vena cava syndrome caused by metastatic lymph node enlargement. In this report, we describe the CT andradionuclide venographic findings.
Collateral Circulation* ; Female ; Humans ; Lymph Nodes ; Pulmonary Veins ; Superior Vena Cava Syndrome* ; Veins ; Vena Cava, Inferior ; Vena Cava, Superior*

As a chronic multisystemic inflammatory disorder, Behcet's disease may manifest vascular, cardiac, neurological and gastrointestinal abnormalities. However, involvement of large veins, such as thrombosis of the superior or inferior vena cava, is a very rare complication. Herein, a case of superior vena cava syndrome, due to the thrombotic obstructions of the subclavian and brachiocephalic vein, is reported in a 27-year old woman with chronic Behcet's disease.
Adult ; Brachiocephalic Veins ; Female ; Humans ; Superior Vena Cava Syndrome* ; Thrombosis ; Veins ; Vena Cava, Inferior ; Vena Cava, Superior*

BACKGROUND: Although radiofrequency catheter ablation (CA) of the accessory pathway (AP) is very effective and safe, it has been reported that CA is more difficult in the right-side AP than the left-side AP, requiring the refinement of the conventional CA technique for the right-side AP. This study was, therefore, aimed to develop an effective technique for CA of the right-side AP. METHODS: Fifty right-side APs in 45 patients which underwent CA were included in this study. The locations of APs were divided into 8 regions (anteroseptal, mid septal, posteroseptal, posterior, posterolateral, lateral, anterolateral, and anterior). After localizing APs, CA of the APs was attempted via the inferior vena cava (IVC) in all patients. If CA attempt via the IVC for more than 1 hour was failed, then CA was tried via the superior vena cava (SVC). Successful CA was defined as permanent loss of AP conduction even during infusion of isoproterenol (1-4microg/min). The ways of approaching the ablation catheter to the successful target sites were classified into over-the-tricuspid valve approach (OV) via the IVC (IVC-OV), OV via the SVC (SVC-OV), under-the-tricuspid valve (UV) approach via the IVC (IVC-UV), and UV via the SVC (SVC-UV) and evaluated according to the AP locations. RESULTS: The locations of the APs were anteroseptal in 5 APs, mid septal in 6, posteroseptal in 12, posterior in 3, posterolateral in 5, right lateral in 11, anterolateral in 4, and anterior in 4. Forty-eight (96.0%) of 50 APs were successfully ablated; 35 (70.0%) with primary IVC approaches and 13 (26.0%) with secondary SVC approaches. As a successful approach, IVC-OV was 26 (54.2%); IVC-UV, 9 (18.8%); SVC-OV, 4 (8.3%), and SVC-UV, 9 (18.8%). Secondary SVC approaches were required 7 (70.0%) in the lateral APs, 2 (50.0%) in the anterolateral APs, 1 (25.0%) of the posterolateral APs, 1 (25.0%) in the anterior APs, 1 (20.0%) of the anteroseptal APs, and 1 (8.3%) in the posteroseptal APs but none in the midseptal and posterior APs. SVC-UV approach was used in 9 (69.2%) in 13 APs which were ablated with SVC approach. CONCLUSIONS: The ways of approach to successful target site in CA of the right-side APs are different according to the location and SVC approaches are frequently required in ablation of the lateral or anterolateral APs. Therefore, SVC approaches should be considered in these locations if the initial IVC approaches are not successful.
Catheter Ablation* ; Catheters* ; Humans ; Isoproterenol ; Vena Cava, Inferior ; Vena Cava, Superior