2/25/2010
Systemic Veins in the thorax & Thoracic duct
Systemic Veins and Thoracic Duct
Development of systemic veins: (Color-coded according to development)
Azygos and Hemiazygos veins:
Pericardial reflections
Anterior view:
Oblique & Transverse Sinuses of pericardium:
Transverse sinus from Echo: (Parasternal long axis view)Figure from "Surgical Anatomy of the Heart - Wilcox, Cook, Anderson" 3rd ed. 2004.
Transverse sinus (Anatomic specimen):
Figure from "Surgical Anatomy of the Heart - Wilcox, Cook, Anderson" 3rd ed. 2004.
Pulmonary vein stenosis
Surgery: Sutureless repair of Pulmonary vein stenosis:
(Lacour-Gayet F, et al. Arch Mal Coeur Vaiss 1996;89:633-36)
(Lacour-Gayet F, et al. Arch Mal Coeur Vaiss 1996;89:633-36)
Modification to Sutureless Repair of Pulmonary vein stenosis (Toronto group):
(Figure from Najm HK, et al. JTCVS 1998;115:468-70
Follow this link for pericardial reflections
Follow this link for pericardial reflections Additional papers:
Seale AN, et al. Heart 2009;95:1944-9. Pulmonary vein stenosis: the UK, Ireland and Sweden collaborative study. Insightful epidemiologic article about this rare disease.
2/21/2010
ALCAPA - Importance of Color Doppler Signal & Unfortunate artifact in 2D
Following 3 images are from a 14 yr old boy complaining of exercise-related dizziness, palpitation and chest discomfort.
Figure 1: Parasternal short axis view...unfortunately has an artifactual drop out which was misleading. Here, LCA appears to be clearly originating from aorta. However, the color Doppler signal in second image raises a red-flag.
Figure 2: This image with color flow Doppler signal in LCA indicates "wrong" direction of flow in LCA. This finding lead to performance of an angiogram (Figure 3).
Figure 3: RAO view of selective left coronary angiogram showing retrograde filling of left coronary system which ultimately drains into Main Pulmonary Artery. Venous catheter is in MPA. 
Retrospectively, there is a "drop-out" of the thin membranous separation between Aorta and LCA which is originating from MPA, but travel close to the wall of aorta. This emphasizes the importance of showing coronary origins both by 2D and color Doppler.
Also, such demonstration with 2D and color Doppler will eliminate possibility of mistaking transverse sinus of the pericardium around the great arteries for coronary arteries by 2D. Color Doppler will show fail to demonstrate flow in transverse sinus (folds of pericardium).
2/19/2010
AHA Scientific Statement - Torsades in Hospital Setting
Feb 2010
Click below to view/get the article from AHA webpage
2/15/2010
Social Issues: Information resources for Families
www.childrenscardiomyopathy.org
(Service by Children's Cardiomyopathy Foundation)
(Service provided by California HEARTconnection, an all-volunteer, nonprofit support network)
Will add more such websites in future.
2/05/2010
ICU - Postop. chest pain
16 yr old boy, Postop after CABG for anomalous aortic origin of RCA from left coronary cusp. Complains of chest pain on first postop. day. (Prior EKG - immediately postop. did not show any ST changes).
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