Faculty Collaboration Database

Inferior sinus venosus defects: anatomic features and echocardiographic correlates. Pediatr Cardiol 2013 Feb;34(2):322-6

Date

08/03/2012

Pubmed ID

22854830

DOI

10.1007/s00246-012-0449-7

Scopus ID

2-s2.0-84879503806 (requires institutional sign-in at Scopus site)   19 Citations

Abstract

Inferior sinus venosus defects (SVDs) are rare imperfections located in the inferior portion of the atrial septum, leading to an overriding inferior vena cava (IVC) and an interatrial connection. These defects have increased risk of anomalous pulmonary venous return (PAPVR) and often are confused with secundum atrial septal defects (ASDs) with inferior extension. The authors sought to review their experience with inferior SVDs and to establish at their institution an echocardiographic definition that differentiates inferior SVDs from secundum ASDs with inferior extension. The study identified 161 patients 1.5 to 32 years of age who had undergone repair of a secundum ASD with inferior extension or inferior SVD over the preceding 10 years. All surgical notes, preoperative transthoracic echocardiograms (TTEs), and preoperative transesophageal echocardiograms (TEEs) were reviewed. Based on the surgical notes, 147 patients were classified as having a secundum ASD (147/161, 91 %) and 14 patients (9 %) as having an inferior SVD. The study identified PAPVR in 7 % (1/14) of the patients with inferior SVDs and 3.5 % (5/14) of the patients with secundum ASDs. Surgical diagnosis and preoperative TTE correlated for 143 (89 %) of the 161 patients. Using a strict anatomic and echocardiographic definition with a blinded observer, the majority of the defects (14/18, 78 %) were reclassified correctly after review of their TTE images, and 100 % of the defects were correctly reclassified after TEE image review. Accurate diagnosis of inferior SVDs remains challenging. The data from this study demonstrate that use of a strict anatomic and echocardiographic definition (a defect that originates in the mouth of the IVC and continues into the inferoposterior border of the left atrium, leaving no residual atrial septal tissue at the inferior margin) allows for accurate differentiation between secundum ASDs with inferior extension and inferior SVDs. This differentiation is extremely important in planning for surgical versus device closure of these rare defects.

Author List

Plymale J, Kolinski K, Frommelt P, Bartz P, Tweddell J, Earing MG

Authors

Peter J. Bartz MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Peter C. Frommelt MD Adjunct Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Cardiac Surgical Procedures
Child
Child, Preschool
Echocardiography, Transesophageal
Follow-Up Studies
Heart Septal Defects, Atrial
Humans
Infant
Preoperative Period
Prognosis
Pulmonary Veins
Retrospective Studies
Vena Cava, Inferior
Young Adult