An unusual case of cerebrovascular accident in a child

An unusual case of cerebrovascular accident in a child Image Focus 1 IMAGE FOCUS doi:10.1093/ehjci/jey070 .................................................................................................................................................... 1 2 3 1 Gopal Chandra Ghosh *, Roshni Julia Rajan , R.V. Leena , and Oomen K. George 1 2 Department of Cardiology, Christian Medical College, Hospital, Vellore, Tamil Nadu, India; Department of Paediatrics, Christian Medical College, Hospital, Vellore, Tamil Nadu, India; and Department of Radiology, Christian Medical College, Hospital, Vellore, Tamil Nadu, India * Corresponding author. Tel: 191 9566341731; Fax: 04163073008. E-mail: gcghosh86@gmail.com A 14 months old girl with his- tory of right sided hemiparesis presented to us with mild cya- nosis. The child was born by a non-consanguineous marriage and her infancy was uneventful. Cardiovascular examination was unremarkable. Oxygen sat- uration was 78–80% in room air. Electrocardiography and chest X-ray were normal. 2D echocardiography showed dilated left atrium (LA) and left ventricle, right superior vena cava (SVC) draining into the LA and normal drainage of inferior vena cava (IVC) into the right atrium (RA) (Panel A, Supple- mentary data online, Video S1). Computed tomography (CT) angiography confirmed our 2D echocardiography findings (Panel B). CT additionally showed right and left brachiocephalic veins and azygous vein, connected to the SVC, which was finally drain- ing into the LA (Panel C). The right upper lobe and middle lobe pulmonary veins were draining into the SVC before entering into the LA (Panel D). Magnetic resonance imaging brain showed left middle cerebral artery territory infarct. SVC drainage into the LA was seen in 0.5% of congenital heart disease patients. Isolated SVC drainage into the LA is rare. Isolated SVC to LA shunt should be kept as a differential diagnosis in patients with unexplained hypoxaemia and relatively normal basic cardiac investiga- tions. Intuitive mind and careful echocardiography can be rewarding. Stroke in our patient was due to this rare underlying right to left shunt. She was advised surgical rechanneling of SVC to RA. (Panel A) 2D echocardiography, subcostal bicaval view showing IVC connects to RA and SVC connects to LA. (Panel B) Coronal reconstructed CT cardiac image showing SVC draining into the LA. (Panel C)3D volume ren- dered CT reconstruction image showing right and left brachiocephalic veins and azygous vein form the SVC (yellow coloured vessels), which finally connects to the LA (purple coloured chamber). (Panel D) Sagittal reconstructed CT cardiac image showing the right upper lobe pulmonary vein connects to SVC before entering into the LA and the right middle lobe pulmonary vein connects to SVC at the junc- tion where SVC enter the LA. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/advance-article-abstract/doi/10.1093/ehjci/jey070/4995000 by Ed 'DeepDyve' Gillespie user on 11 July 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

An unusual case of cerebrovascular accident in a child

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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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2047-2404
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10.1093/ehjci/jey070
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Abstract

Image Focus 1 IMAGE FOCUS doi:10.1093/ehjci/jey070 .................................................................................................................................................... 1 2 3 1 Gopal Chandra Ghosh *, Roshni Julia Rajan , R.V. Leena , and Oomen K. George 1 2 Department of Cardiology, Christian Medical College, Hospital, Vellore, Tamil Nadu, India; Department of Paediatrics, Christian Medical College, Hospital, Vellore, Tamil Nadu, India; and Department of Radiology, Christian Medical College, Hospital, Vellore, Tamil Nadu, India * Corresponding author. Tel: 191 9566341731; Fax: 04163073008. E-mail: gcghosh86@gmail.com A 14 months old girl with his- tory of right sided hemiparesis presented to us with mild cya- nosis. The child was born by a non-consanguineous marriage and her infancy was uneventful. Cardiovascular examination was unremarkable. Oxygen sat- uration was 78–80% in room air. Electrocardiography and chest X-ray were normal. 2D echocardiography showed dilated left atrium (LA) and left ventricle, right superior vena cava (SVC) draining into the LA and normal drainage of inferior vena cava (IVC) into the right atrium (RA) (Panel A, Supple- mentary data online, Video S1). Computed tomography (CT) angiography confirmed our 2D echocardiography findings (Panel B). CT additionally showed right and left brachiocephalic veins and azygous vein, connected to the SVC, which was finally drain- ing into the LA (Panel C). The right upper lobe and middle lobe pulmonary veins were draining into the SVC before entering into the LA (Panel D). Magnetic resonance imaging brain showed left middle cerebral artery territory infarct. SVC drainage into the LA was seen in 0.5% of congenital heart disease patients. Isolated SVC drainage into the LA is rare. Isolated SVC to LA shunt should be kept as a differential diagnosis in patients with unexplained hypoxaemia and relatively normal basic cardiac investiga- tions. Intuitive mind and careful echocardiography can be rewarding. Stroke in our patient was due to this rare underlying right to left shunt. She was advised surgical rechanneling of SVC to RA. (Panel A) 2D echocardiography, subcostal bicaval view showing IVC connects to RA and SVC connects to LA. (Panel B) Coronal reconstructed CT cardiac image showing SVC draining into the LA. (Panel C)3D volume ren- dered CT reconstruction image showing right and left brachiocephalic veins and azygous vein form the SVC (yellow coloured vessels), which finally connects to the LA (purple coloured chamber). (Panel D) Sagittal reconstructed CT cardiac image showing the right upper lobe pulmonary vein connects to SVC before entering into the LA and the right middle lobe pulmonary vein connects to SVC at the junc- tion where SVC enter the LA. Supplementary data are available at European Heart Journal - Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/advance-article-abstract/doi/10.1093/ehjci/jey070/4995000 by Ed 'DeepDyve' Gillespie user on 11 July 2018

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European Heart Journal – Cardiovascular ImagingOxford University Press

Published: May 10, 2018

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