Multimodal Imaging for Total Anomalous Systemic Venous Drainage Diagnosis and Preoperative Planning: A Case Report and Literature Review

Abstract

Total anomalous systemic venous drainage (TASVD) is a rare congenital heart malformation. Here, we report a case of a 40-year-old male patient who had a total anomalous systemic venous drainage. It was diagnosed as the TASVD for the first time through multimodal imaging combined Transthoracic (TTE), transesophageal (TEE) and three-dimensional (3D-TTE) echocardiography, contrast echocardiography and computed tomography angiography (CTA). We review 15 published reports on TASVD and summarize the ultrasonographic characteristics. After intracardiac repair through ectopic venous drainage in cardiac surgery, the patient's cyanosis symptoms were alleviated greatly. Echocardiography was the first-line examination for TASVD. Multimodal imaging combined TTE, TEE, 3D TEE, contrast echocardiography and CTA was necessary for confirmed diagnosis of TASVCD.

Keywords: computed tomography angiography; coronary sinus atrial septal defect; echocardiography; multimodal imaging; total anomalous systemic venous drainage.

Figure 1

Echocardiography and computed tomography angiography. (A) complete coronary sinus atrial septal defect (white arrowheads). (B) white arrowheads show an abnormal conduit. (C) A connection between the inferior vena cava and the left atrium. (D) saline microbubbles injected into the lower limb vein expressed first in the LA and left ventricle (LV), and then in the RA and RV. (E) saline microbubbles injected into the right elbow vein expressed almost simultaneously in the LA and RA. (F) CT shows the left superior vena cava and the inferior vena cava draining into the LA. (G–I) CT shows the superior vena cava (white arrowheads) draining into the.