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Case Reports
. 2021 Dec 31;6(3):107-113.
doi: 10.1016/j.case.2021.12.002. eCollection 2022 May.

Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults

Jessica K Qiu  1 , Daniel Bamira  1 , Alan F Vainrib  1 , Larry A Latson  2 , Dan G Halpern  1 , Anne Chun  3 , Muhamed Saric  1
Affiliations
Case Reports

Multimodality Imaging of Sinus Venosus Atrial Septal Defect: A Challenging Diagnosis in Adults

Jessica K Qiu et al. CASE (Phila). .
No abstract available

Keywords: 3D echocardiography; Atrial septal defect; Computed tomography; Magnetic resonance imaging; Sinus venosus.

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Figures

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Graphical abstract
Figure 1
Figure 1
Case 1: SVC-type SVASD on TTE in adult. Direct demonstration of the actual SVC-type SVASD is often difficult on TTE in adults. Such a diagnosis should be suspected when there is an unexplained right heart dilatation (A) and when Doppler imaging demonstrates a significant left-to-right shunt (B and C). Video 1 demonstrates significant and unexplained right heart dilatation. AV, Aortic valve; d, diameter; LA, left atrium; LV, left ventricle; LVOT, left ventricular outflow tract; Qp, pulmonic flow; Qs, systemic flow; RVOT, RV outflow tracts; VTI, velocity-time integral.
Figure 2
Figure 2
Case 1: SVC-type SVASD with anomalous pulmonary venous drainage on TEE in adult. An SVC-type SVASD can be directly demonstrated on 2D TEE (A) and 3D TEE (B, C, and D). Video 2 corresponds to panel A. Video 3 corresponds to panels B and C. To successfully image this type of ASD on TEE, it is important to visualize the SVC in short- and long-axis views on 2D TEE first, followed by 3D zoom imaging of the defect. The 3D data set is then rotated using the TUPLE maneuver previously published by our group.AV, Aortic valve; LA, left atrium; RA, right atrium; RMPV, right middle pulmonary vein; RPA, right pulmonary artery; RUPV, right upper pulmonary vein.
Figure 3
Figure 3
Case 2: SVC-type SVASD with anomalous pulmonary venous drainage on CCT in adult. (A) Sagittal view demonstrates abnormal interatrial communication indicative of an SVC-type SVASD. (B) The RUPV drains anomalously into the SVC as visualized on an axial cut. (C) In contrast, the RLPV drains normally into the left atrium on an axial cut. Ao, Ascending aorta; LA, left atrium; LV, left ventricle; PA, main pulmonary artery; RA, right atrium; RLPV, right lower pulmonary vein; RUPV, right upper pulmonary vein.
Figure 4
Figure 4
Case 3: SVC-type SVASD with anomalous pulmonary venous drainage on CMR in adult. Sagittal cuts demonstrated an SVC-type SVASD (A) and anomalous pulmonary venous drainage (B). Note the right heart dilatation in panels C and D resulting from a double shunt (from ASD and anomalous pulmonary venous drainage). LA, Left atrium; LV, left ventricle; RA, right atrium; RMPV, right middle pulmonary vein; RUPV, right upper pulmonary vein.
Figure 5
Figure 5
Case 4: IVC-type SVASD in adult on TTE, TEE, and CMR. Inferoposteriorly located IVC-type SVC is visualized on subcostal TTE view (A) and 2D TEE (B) with and without color Doppler. Cardiovascular magnetic resonance demonstrates anomalous pulmonary venous drainage (C and D). Video 4 corresponds to panels A and B. Ao, Ascending aorta; LA, left atrium; PVs, pulmonary veins; RLPV, right lower pulmonary vein; RMPV, right middle pulmonary vein.
Figure 6
Figure 6
An SVC-type SVASD with anomalous pulmonary venous drainage on TTE in a child, as visualized by subcostal (A) and right parasternal (B) views. On pediatric TTE, it is often easier to demonstrate the SVC-type SVASD (also referred to as superior ASD) and associated anomalous pulmonary venous drainage than in adults. Video 5 corresponds to this figure. LA, Left atrium; RA, right atrium; RUPV, right upper pulmonary vein.
Figure 7
Figure 7
An IVC-type SVASD with anomalous pulmonary venous drainage on TTE in a child. On pediatric TTE, it is often easier to demonstrate the IVC-type SVASD (also referred to as inferior ASD) with an overriding IVC than in adults. Video 6 corresponds to this figure. LA, Left atrium; RA, right atrium.
See this image and copyright information in PMC

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