Measures of Dispersion and Variability: Range, QD, AD and SD
Systemic venous anomalies
1. SYSTEMIC VENOUS ANOMALIES
Dr Ranjith MP
Senior Resident
Department of Cardiology
Government Medical college
Kozhikode
2. EMBRYOLOGY
Heart- First organ to start functioning & the 1st organ to fully
develop in the fetus
First seen as 2 endothelial heart tube
21 days - heart tube forms
23 days- heart beats
Week 4 - cardiac loop forms
Week 7 - heart fully developed
5. EMBRYOLOGY
In the fifth week, three pairs of major veins can be
distinguished:
1. The vitelline veins (omphalomesenteric veins)
carrying blood from the yolk sac to the sinus venosus
2. The umbilical veins
originating in the chorionic villi, carrying oxygenated blood to the
embryo
3. The cardinal veins
draining the body of the embryo proper
7. EMBRYOLOGY
Cardinal Veins
The anterior cardinal veins drains the cephalic part of the embryo
The posterior cardinal veins drains the rest of the embryo
The anterior and posterior veins join before entering the sinus
horn and form the short common cardinal veins (ducts of Cuvier)
During the fourth week, the cardinal veins form a symmetrical
system
8. EMBRYOLOGY
Development of veins draining upper part of body
A. Ducts of Cuvier
B. Subclavian veins
C. Transverse anastomosis
E. Superior venacava
F. Right Brachiocephalic vein
G. Left Brachiocephalic vein
H. Internal Jugular vein
External jugular vein arise
as secondary channel
9. EMBRYOLOGY
Development of Inferior venacava
B. Vitelline and umbulical vein
broken in to numerous channel
C. Formation of Hepatocardiac
channel
D. Formation of Common
hepatic vein & Ductus venosus
10. EMBRYOLOGY
Development of Inferior venacava
During the fifth to the seventh week a number of additional
veins are formed:
1.The subcardinal veins, mainly drain the kidneys
2.The sacrocardinal veins, drain the lower extremities
3.The supracardinal veins, drain the body wall by way of the
intercostal veins, taking over the functions of the posterior
cardinal veins
12. EMBRYOLOGY
Development of Inferior venacava
The anastomosis between the subcardinal veins forms the
left renal vein
The left subcardinal vein disappears, and only its distal
portion remains as the left gonadal vein
The right subcardinal vein becomes the main drainage
channel and develops into the renal segment of the inferior
vena cava
13. EMBRYOLOGY
Development of Inferior venacava
The anastomosis between the sacrocardinal veins forms the
left common iliac vein
The right sacrocardinal vein becomes the sacrocardinal
segment of the inferior vena cava
When the renal segment of the IVC connects with the
hepatic segment, the IVC (consisting of hepatic, renal, and
sacrocardinal segments) is complete
15. EMBRYOLOGY
Development of Azygos veins
The 4thto 11th right intercostal veins empty into the
right supracardinal vein, which together with a portion
of the posterior cardinal vein forms the azygos vein
On the left the 4th to 7th intercostal veins enter into
the left supracardinal vein, and the left supracardinal
vein, then known as the hemiazygos vein, empties into
the azygos vein
18. Anomalies of the SVC
Bilateral SVC with normal drainage
Bilateral SVC with an Unroofed Coronary Sinus
Absent Right SVC in Visceroatrial Situs Solitus
Left Atrial or Biatrial Drainage of Right SVC
Retroaortic Innominate Vein
19. Bilateral Superior Venae Cavae with Normal
Drainage to the Right Atrium
Result from failure of the left anterior and left common
cardinal veins to involute
The incidence is 0.3%
LSVC drains into RA through CS in 92%
-in to LA by unroofed CS in 8%
20. Bilateral Superior Venae Cavae with Normal
Drainage to the Right Atrium
superior vena cava A=right B=left A: coronary sinus (enlarged)
C: communicating vein, D: aorta B: aorta, C: inferior vena cava
E: pulmonary trunk. D: left pulmonary veins
21. Bilateral Superior Venae Cavae with Normal
Drainage to the Right Atrium
Anatomy
The size of the LSVC varies
left innominate vein may be present in 60%
The LSVC starts at the junction of the left jugular and
left subclavian veins
Joins the CS in the posterior left AV groove
22. Bilateral Superior Venae Cavae with Normal
Drainage to the Right Atrium
Clinical Manifestations
Physiology is usually normal & no clinical
manifestations
Enlargement of the CS may interfere with blood flow
from the LA into the LV
An increase in the magnitude of the Lt to Rt shunt at
the atrial level was found in patients with secundum
ASD persistent LSVC, and dilated coronary sinus
23. Bilateral SVC to Right Atrium
Diagnostic Features
Chest Xray
Shadow along the Lt upper border of the mediastinum
2D echo 100% specificity & 96% sensitivity
A dilated CS is often the first clue to the diagnosis
Imaged from the suprasternal notch or from the high left
parasternal/subclavicular windows
Presence & size of the Lt innominate vein can also be imaged
24. Bilateral Superior Venae Cavae with Normal
Drainage to the Right Atrium
2D echo
There is an inverse relationship between the caliber of
the LSVC and the left innominate vein
May confuse with a TAPVC or PAPVC, left superior
intercostal vein, and a levoatrialcardinal vein
In contrast to a LSVC to an intact coronary sinus,
however, the direction of blood flow in these veins is
expected to be into the left innominate vein
25. Bilateral SVC to Right Atrium
Diagnostic Features
A: Subcostal long-axis
view
B: Parasternal long-
axis view
C: The LSVC is seen
anterior to LPA in the
parasternal short-axis
view
D: The drainage of the
LSVC to the CS and to
RA seen in parasternal
sagittal view
26. Bilateral SVC to Right Atrium
Diagnostic Features
Cardiac catheterization
LSVC can be suspected by the presence of higher-than-
expected CS oxygen saturation
The LSVC can be approached either through the right SVC
(when the innominate vein is present) or through the
coronary sinus
Left innominate vein angiography with balloon occlusion
proximal to the injection site is diagnostic
27. Bilateral Superior Venae Cavae with Normal
Drainage to the Right Atrium
Treatment- No treatment is
necessary for an isolated LSVC to
an intact coronary sinus
28. Bilateral SVC with an Unroofed Coronary Sinus
Anatomy
Common wall between the LA & CS absent
Persistent LSVC drains into the left atrium
In patients with a normal inter atrial septum, the orifice of
the unroofed CS will function as an interatrial
communication
Visceral heterotaxy with asplenia exhibits the highest
incidence of bilateral SVCs with a completely unroofed
coronary sinus
29. Bilateral SVC with an Unroofed Coronary Sinus
Clinical Manifestations
Most patients have a large CS ostium that functions as
an interatrial communication (Raghib syndrome)
Cyanosis and left-to-right shunting
In most patients, the arterial oxygen saturation ranges
between 85% and 95%
They are at risk for complications of right-to-left
shunting, including paradoxical emboli, brain abscess,
strokes, and death
30. Bilateral SVC with an Unroofed Coronary Sinus
Clinical Manifestations
In patients with atretic CS ostium the only clinical
manifestations are cyanosis and its sequelae
When right atrial outflow stenosis or atresia coexists
with a persistent LSVC to an unroofed coronary sinus,
the shunt is exclusively from right to left
31. Bilateral SVC with an Unroofed Coronary Sinus
Diagnostic Features
ECG
Axis of the P wave may be abnormal in patients with
heterotaxy syndrome
Chest Xray
Shadow along the Lt upper border of the mediastinum
32. Bilateral SVC with an Unroofed Coronary Sinus
Diagnostic Features
Echocardiography-the definitive imaging modality
The posterior left AV groove is examined in detail to ascertain the extent of
deficiency of the CS septum
When the CS septum is completely unroofed, the LSVC terminates in the upper
Lt posterior corner of the LA between the LUPV posteriorly and the LA
appendage anteriorly
Color Doppler or contrast injection demonstrates flow from the LSVC into LA
Cardiac catheterization
Step-down in oxygen saturation between PV & LA
LSVC selective angiocardiography
33. Bilateral SVC with an Unroofed Coronary Sinus
Diagnostic Features
B.MR image in a coronal plane
A. Injection into the LSVC shows complete unroofing of
opacifies CS and shunting of the CS. LSVC connects to the
contrast medium into the LA roof of the LA and the CS
thorough the defect opening functions as a LA
septal defect (Raghib defect)
34. Bilateral SVC with an Unroofed Coronary Sinus
Treatment
Repair is done to avoid complications of cyanosis
If the LSVC is relatively small and there is an adequate-
sized left innominate vein, the LSVC can be ligated and
the interatrial communication closed
In the absence of an adequate-sized bridging left
innominate vein, the coronary sinus is reroofed
Baffling the LSVC along the posterior wall of the LA in to RA
ASD device closure of CS defect
35. Absent Right SVC in Visceroatrial Situs
Solitus
0.07% to 0.13% of cardiovascular malformations
Characterized by persistence of the LSVC draining to
the RA via the CS and by left-sided azygos vein
draining into the LSVC
Less constant features
Additional cardiovascular malformations (46%)
Rhythm abnormalities (35%)
36. Absent Right SVC in Visceroatrial Situs
Solitus
Clinical Manifestations
Usually asymptomatic
Rhythm disturbances
Atrioventricular block
sinoatrial node dysfunction
ventricular tachycardia
Left and right bundle-branch block
supraventricular tachycardia
Sudden death
37. Absent Right SVC in Visceroatrial Situs
Solitus
Diagnostic Features
Issues that make diagnosis important are
– Implantation of transvenous pacemaker
– Placement of a pulmonary artery catheter for intraoperative or
postoperative monitoring without the use of fluoroscopy
– Systemic venous cannulation for extracorporeal membrane
oxygenation
– Systemic venous cannulation for cardiopulmonary bypass
– Partial or total cavopulmonary anastomosis
– Orthotopic heart transplantation and endomyocardial biopsies
Diagnosis established by echocardiography, MRI, CT, or angiography
38. Absent Right SVC in Visceroatrial Situs
Solitus
Treatment
No intervention is indicated
when the physiology is normal
Venogram in the innominate vein in a patient
with absence of the right SVC and persistence of
the LSVC, which drains into the RA via the CS
39. Left Atrial or Biatrial Drainage of Right SVC
It represents a sinus venosus defect of the
SVC type in association with atresia of the
right SVC orifice
It results from the deficiency of the common
wall between the SVC & RUPV
This defect unroofs the RUPV & its branches
into the right SVC
The unroofed RUPV then drains into the SVC,
and its LA orifice becomes the interatrial
communication
40. Left Atrial or Biatrial Drainage of Right SVC
Clinical Manifestations
Cyanosis is the dominant clinical feature
symptoms may not develop until late childhood or
adolescence
The risks of Rt to Lt shunt sequelae increase with age
Diagnosis
Demonstration of a common entrance site of Rt SVC
and the RUPV in the roof of the LA by echo or angio
41. Left Atrial or Biatrial Drainage of Right SVC
Treatment
The right SVC flow is surgically diverted into the RA
In the past, this was done by creating an ASD and
redirecting SVC flow into RA and the pulmonary blood
flow into LA
Preferred surgical approach is transection of the right
SVC above the entrance of the RUPV and anastomosis
of the transected caval end to the RA appendage
42. Retroaortic Innominate Vein
First reported in 1888, and 62 cases have been reported
to date
Also known as postaortic innominate vein
Anatomy
Characterized by an abnormal position of the left innominate vein
behind the ascending aorta
Normal course of the left innominate vein is from left to right, anterior
to the aortic arch
In RAIV it is horizontally behind the ascending aorta to reach the SVC
below the insertion of the azygos vein
43. Retroaortic Innominate Vein
Most patients have associated cardiac malformations
Embryology
Results from failure of the high transverse capillary plexus
that forms the left innominate vein to develop
In such circumstance, venous blood returning from the Lt
side of the head and the Lt arm may drain through a lower
venous plexus that communicates between the Lt & Rt
anterior cardinal veins
This lower venous plexus then forms the RAIV
44. Retroaortic Innominate Vein
A: Diagram showing a RAIV associated with a
. right aortic arch in a patient with TOF, RSVC
B: Gadolinium-enhanced MR angiogram showing a
. retroaortic innominate vein
45. Retroaortic Innominate Vein
Clinical Manifestations
Asymptomatic
Surgical importance
Diagnosis
Echo, angio or MRI
Accurate echocardiographic diagnosis is based on tracking
the left innominate vein from its origin through its
retroaortic course to the SVC
Cine MRI and three-dimensional MRA are particularly useful
in depicting the anatomy
Treatment-No treatment is necessary
46. Levoatrialcardinal vein
First described Edwards and DuShane in 1950 as
a vein connecting the rt. SVC and LA
Remnant of an early embryonic venous channel
that connects the splanchnic plexus of the lungs
with the cardinal system
In the mature heart, it connects the LA or a PV
with the Lt innominate or other systemic veins
Typically It is associated with severe LA outlet
obstruction
47. Levoatrialcardinal vein
The diagnosis can be established by
following the anomalous vein from its
origin to its termination in a systemic
vein
Unlike persistent LSVC that courses
anterior to the left pulmonary artery, a
levoatrialcardinal vein typically ascends
posterior to it
Levoatriocardinal vein in a
patient with cortriatriatum. It
It complicates the completion of a drains the proximal chamber of
Fontan-type operation the LA to the innominate vein
48. Levoatrialcardinal vein
Multiplanar reformated
image showing a
levoatriocardinal vein (arrow)
connecting an anomalous
vein draining into the IVC and
a pulmonary vein draining in
to LA
50. Anomalies of the Coronary Sinus
Coronary Sinus Defect and Unroofed CS
Coronary Sinus Orifice Atresia
Coronary Sinus Aneurysm or Diverticulum
51. Coronary Sinus Defect & Unroofed CS
Unroofed coronary sinus almost always is associated
with a persistent LSVC
A CS defect without an associated LSVC, and the
physiology is the same as in ASD
Diagnosis- Echo, Color Doppler, Contrast echo
Surgery is usually performed for associated
malformations
52. Coronary Sinus Orifice Atresia
Incidence is rare
The CS is usually well formed, the orifice is covered
by a thin membrane like tissue
Alternative exit for coronary venous blood return-
A small LSVC , Large thebesian vein
CS septal defect , Connection with the IVC in one case
53. Coronary Sinus Orifice Atresia
Clinical Manifestations
Myocardial ischemia is unlikely as
long as there is an alternate egress
for the coronary sinus blood
Diagnostic Features
Suspected by the echo demonstration
of a persistent LSVC to an intact CS with retrograde flow
Angiographic demonstration of retrograde flow in the coronary
sinus and a small caliber LSVC is suggestive of the diagnosis
54. Coronary Sinus Aneurysm or Diverticulum
First described in 1983 by Ho et al
It is a pouch with its neck originating in the CS proximal to the
entrance of the middle cardiac vein. The pouch, 2 to 5 cm in
diameter, extends into the LV wall
It may be associated with WPW syndrome (posteroseptal accessory
pathways)
Diagnostic Features
diagnosed by echocardiography
Imaged from the subcostal, apical, and parasternal windows
Seen as an outpouch, typically with a distinct neck, which extends behind the
LV or into the ventricular myocardium
55. Coronary Sinus Aneurysm or Diverticulum
Treatment
Intervention indicated in patients with arrhythmia
Conduction abnormality disappears only after separation or
ablation of the CS diverticulum neck
The CS was dissected away from the LV and the AV junction
and that site was cryoablated
No postoperative recurrences or complications occurred
57. Anomalies of the Inferior Vena Cava
Interrupted Inferior Vena Cava
Bilateral Inferior Vena Cavae
Inferior Vena Cava drainage to the Left Atrium
58. Interrupted Inferior Vena Cava
Anatomy
Absence of the hepatic segment of the IVC with azygos
continuation into the right or left
Rarely the infrahepatic segment of the IVC may continue to
both right and left SVC via bilateral azygos veins
One of the characteristics of the polysplenia syndrome
Also has been reported in patients with normal hearts and
rarely in patients with asplenia
59. Interrupted Inferior Vena Cava
Posterior view of the
heart, lungs, liver, and
kidneys of a 6 1/2-
month-old boy with
visceral heterotaxy and
left-sided polysplenia.
There is interruption of
the right-sided IVC with
bilateral azygos veins
connecting with
bilateral superior venae
60. Interrupted Inferior Vena Cava
Clinical Manifestations
Interrupted IVC with azygos continuation usually does not result in a
physiologic abnormality
Can complicate cardiac catheterization and interventional procedures
Diagnostic Features
Diagnosed readily by echocardiography
Diagnosis is based on imaging of the size, location, and course of the
IVC and the azygos vein
61. Interrupted Inferior Vena Cava
Diagnostic Features
Normally, in the subcostal short-axis view, the renal-to-hepatic
segment of the IVC is seen as an oval blood vessel located anterior
and to the right of the abdominal aorta
In heterotaxy syndrome, the IVC may be juxtaposed to the abdominal
aorta either to the left or to the right of the spine
When the renal-to-hepatic segment of the IVC is absent, no IVC is
seen below the liver
Drainage of the azygos vein to the SVC- can be imaged from the
parasternal and suprasternal windows
62. Interrupted Inferior Vena Cava
three-dimensional MRA is accurate and effective in delineating
normal and abnormal systemic venous anatomy
During cardiac catheterization, venous angiography from the lower
extremity is diagnostic
Treatment
No specific treatment of an interrupted IVC with azygos
continuation is indicated
Inadvertent ligation of the azygos vein can lead to death
63. Bilateral Inferior Venae Cavae
Anatomy
Bilateral suprahepatic IVCs (i.e., a normal IVC and a contralateral
hepatic vein) a frequent finding in cases of visceral heterotaxy with
asplenia
Bilateral suprahepatic IVCs also can occur rarely in patients with
normal visceral situs
The left-sided hepatic vein in those cases drains into a normal
coronary sinus
Do not produce any hemodynamic disturbance
64. Inferior Vena Cava Drainage to the LA
Anatomy
During fetal life, about half of the IVC blood that enters
the RA is directed toward the LA with the help of two
venous valves: the eustachian valve & valve of the
foramen ovale
A left atrial IVC also occur in cases in which all the
systemic and all the PVs drained into a left-sided atrium
65. Inferior Vena Cava Drainage to the LA
AP venogram in a 15-month-old boy with visceral heterotaxy, asplenia. Contrast injected into the
rt. iliac vein filled two venous pathways. The rt-sided pathway represents a rt. IVC, which
receives the rt hepatic vein & then enters the rt side of the common atrium. The lt venous
channel appears to represent a lt. IVC, which connects with the left hepatic vein & then joins the
RIVC and drains into the common atrium via a common orifice.
66. Inferior Vena Cava Drainage to the LA
Clinical Manifestations
Partial or complete drainage of the IVC into the left atrium results
in cyanosis
The clinical manifestations are the result of right-to-left shunting,
including polycythemia, brain abscess, and paradoxical emboli
Treatment
Inferior vena cava blood is surgically redirected into the right
atrium
68. Anomalies of the Ductus Venosus
Anomalous Termination of the Umbilical Veins
and Absent Ductus Venosus
Postnatal Persistence of the Ductus Venosus
Persistent Valves of the Sinus Venosus
69. Anomalous Termination of the Umbilical Veins
and Absent Ductus Venosus
Anatomy
Persisted left umbulical vein terminates directly into the CS , to the CS by way
of the left portal vein or into the iliac vein
Persisted right umbilical vein terminates directly into the RA, into the IVC, into
the rt portal vein & into the right SVC
Clinical Manifestations
Usually do not produce symptoms
Intrauterine obstruction of the umbilical vein flow and postnatal intestinal
obstructions secondary to the anomalous termination of the umbilical veins
have been reported
70. Anomalous Termination of the Umbilical Veins
and Absent Ductus Venosus
Diagnosis
Catheterization of the umbilical vein
Cardiac catheterization plus angiography
Prenatal echocardiography
Postnatal echocardiography
71. Postnatal Persistence of the Ductus
Venosus
Anatomy
Congenital postnatal persistence of the ductus venosus because
the shunt was away from the portal venous septum proximally to
the distal hepatic veins or IVC distally
These intrahepatic portal-systemic shunts are due to abnormal
persistence of elements of the omphalomesenteric system
Clinical Manifestations
Three of the ten cases reported resulted in portal-systemic
encephalopathy
72. Postnatal Persistence of the Ductus
Venosus
Diagnosis
Ultrasound or computed tomography - demonstrates a large tortuous
vessel originating from the portal vein that connected to the hepatic
vein or IVC
Treatment
In the absence of encephalopathy, treatment may not be indicated
If ligation of the ductus venosus is contemplated, one should establish
the integrity of the portal system. If it is not intact, ligation could lead
to mesenteric venous congestion and ultimately bowel ischemia
76. MCQ-1
False statement about development of heart
A. 21 days - heart tube forms
B. 23 days- heart beats
C. Week 6 - cardiac loop forms
D. Week 7 - heart fully developed
77. MCQ-2
False statement about development of Systemic veins
A. Sinus venosus absorbed in to right atrium
B. Left horn of sinus venosus form coronary sinus
C. SVC derived from rt. Posterior cardinal vein and common
cardinal vein
D. Lt. brachiocephalic vein derived from the part of left anterior
cardinal vein
78. MCQ-3
All are true statements except
A. Subclavian vein derived from intersegmental vein
B. External jugular derived from anterior cardinal vein
C. Lt. Superior intercostal vein formed from lt. anterior and
posterior cardinal vein
D. Transverse intercardinal anastomosis form part of left
brachiocephalic vein
79. MCQ-4
Inferior venacava formed by all except
A. Supracardinal veins
B. Subcardinal veins
C. vitelline veins
D. Umbulical veins
E. Posterior cardinal veins
80. MCQ-5
Bilateral SVC with normal drainage to the RA false statement is
A. left innominate vein may be present in 60%
B. The LSVC starts at the junction of the left jugular and left subclavian
veins
C. In LSVC to an intact coronary sinus the direction of blood flow is into the
left innominate vein
D. A dilated CS is often the first clue to the diagnosis
E. There is an inverse relationship between the caliber of the LSVC and the
left innominate vein
81. MCQ-6
All are true statements except
A. Visceral heterotaxy with asplenia exhibits the highest incidence of
bilateral SVCs with a completely unroofed coronary sinus
B. Raghib syndrome characterized by cyanosis with right-to-left shunting
C. In patients with atretic CS ostium & LSVC the only clinical manifestations
are cyanosis and its sequelae
D. In bilateral SVC with an Unroofed CS the arterial oxygen saturation
ranges between 85% and 95%
82. MCQ-7
False statement about Retroaortic Innominate Vein
A. Most patients have associated cardiac malformations
B. Results from failure of the low transverse capillary plexus that
forms the left innominate vein to develop
C. Cine MRI and three-dimensional MRA are particularly useful in
depicting the anatomy
D. Normal course of the left innominate vein is from left to right,
anterior to the aortic arch
83. MCQ-8
False statement about Levoatrialcardinal vein
A. Remnant of an early embryonic venous channel that connects the
splanchnic plexus of the lungs with the cardinal system
B. Typically It is associated with severe LA outlet obstruction
C. It courses anterior to the left pulmonary artery
D. In the mature heart, it connects the LA or a PV with the Lt
innominate or other systemic veins
84. MCQ-9
False statement regarding Coronary Sinus Defect and
Unroofed CS
A. A CS defect without an associated LSVC the physiology is the same
as in ASD
B. Step-up in oxygen saturation between PV & LA
C. Surgery is usually performed for associated malformations
D. Unroofed coronary sinus almost always is associated with a
persistent LSVC
85. MCQ-10
False statement about Interrupted IVC
A. Interrupted IVC with azygos continuation usually does not result in
a physiologic abnormality
B. It is characteristics of the asplenia syndrome
C. Absence of the hepatic segment of the IVC with azygos
continuation into the right or left
D. No specific treatment of an interrupted IVC with azygos
continuation is indicated
87. MCQ-1
False statement about development of heart
A. 21 days - heart tube forms
B. 23 days- heart beats
C. Week 6 - cardiac loop forms
D. Week 7 - heart fully developed
88. MCQ-2
False statement about development of Systemic veins
A. Sinus venosus absorbed in to right atrium
B. Left horn of sinus venosus form coronary sinus
C. SVC derived from rt. Posterior cardinal vein and common
cardinal vein
D. Lt. brachiocephalic vein derived from the part of left anterior
cardinal vein
89. MCQ-3
All are true statements except
A. Subclavian vein derived from intersegmental vein
B. External jugular derived from anterior cardinal vein
C. Lt. Superior intercostal vein formed from lt. anterior and
posterior cardinal vein
D. Transverse intercardinal anastomosis form part of left
brachiocephalic vein
90. MCQ-4
Inferior venacava formed by all except
A. Supracardinal veins
B. Subcardinal veins
C. vitelline veins
D. Umbulical veins
E. Posterior cardinal veins
91. MCQ-5
Bilateral SVC with normal drainage to the RA false statement is
A. left innominate vein may be present in 60%
B. The LSVC starts at the junction of the left jugular and left subclavian
veins
C. In LSVC to an intact coronary sinus the direction of blood flow is into the
left innominate vein
D. A dilated CS is often the first clue to the diagnosis
E. There is an inverse relationship between the caliber of the LSVC and the
left innominate vein
92. MCQ-6
All are true statements except
A. Visceral heterotaxy with asplenia exhibits the highest incidence of
bilateral SVCs with a completely unroofed coronary sinus
B. Raghib syndrome characterized by cyanosis with right-to-left
shunting
C. In patients with atretic CS ostium & LSVC the only clinical
manifestations are cyanosis and its sequelae
D. In bilateral SVC with an Unroofed CS the arterial oxygen saturation
ranges between 85% and 95%
93. MCQ-7
False statement about Retroaortic Innominate Vein
A. Most patients have associated cardiac malformations
B. Results from failure of the low transverse capillary plexus that
forms the left innominate vein to develop
C. Cine MRI and three-dimensional MRA are particularly useful in
depicting the anatomy
D. Normal course of the left innominate vein is from left to right,
anterior to the aortic arch
94. MCQ-8
False statement about Levoatrialcardinal vein
A. Remnant of an early embryonic venous channel that connects the
splanchnic plexus of the lungs with the cardinal system
B. Typically It is associated with severe LA outlet obstruction
C. It courses anterior to the left pulmonary artery
D. In the mature heart, it connects the LA or a PV with the Lt
innominate or other systemic veins
95. MCQ-9
False statement regarding Coronary Sinus Defect and
Unroofed CS
A. A CS defect without an associated LSVC the physiology is the same
as in ASD
B. Step-up in oxygen saturation between PV & LA
C. Surgery is usually performed for associated malformations
D. Unroofed coronary sinus almost always is associated with a
persistent LSVC
96. MCQ-10
False statement about Interrupted IVC
A. Interrupted IVC with azygos continuation usually does not result in
a physiologic abnormality
B. It is characteristics of the asplenia syndrome
C. Absence of the hepatic segment of the IVC with azygos
continuation into the right or left
D. No specific treatment of an interrupted IVC with azygos
continuation is indicated