case_images: PMC11198935_01
case_images: (a-c) The panels show the aneurysmal vein of Galen before (a and b) and after (b) by its embolization using coil-assisted glue copolymer
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case_images: apc_170_23-f001
case_images: A 6-month-old boy (weight: 8.6 kg) underwent four sessions of endovascular treatment to occlude an aneurysm of the vein of Galen and was scheduled for further neurological interventions [Figure 1a-c]. The left-sided chambers were significantly dilated at greater than the 2nd centile [Figure 2a-d and Video 1].
case_images: (a-d) Modified bi-caval (a) and modified high parasternal (b) transthoracic echocardiographic images with color flow mapping showing the right superior caval vein daring into the morphologically left atrium, with the inferior caval vein draining to the right atrium, (c and d) the left superior caval vein draining to the right atrium through the coronary sinus. RSCV: Right superior caval vein, LA: Left atrium, RA: Right atrium, ICV: Inferior caval vein, LSCV: Left superior caval vein
case_images: APC-17-77-g002.jpg
case_images: PMC11198935_01_APC-17-77-g002.jpg
case_images: apc_170_23-f002
case_images: The left-sided chambers were significantly dilated at greater than the 2nd centile [Figure 2a-d and Video 1]. Contrast injection into the right internal jugular vein, however, revealed the presence of two bridging brachiocephalic veins, one closer to the aortic arch and another at the root of the neck lying anterior to the trachea, as well as the drainage pattern of the right and left superior caval veins [Figure 4a-c and Video 2].
case_images: (a and b) Three-dimensional computed tomography endocast (a) and virtual dissection (b) reconstructions show the right superior caval vein (RSCV) draining to the left atrium (LA), anomalous connections of the right upper and middle pulmonary veins just above the junction between the RSCV and LA. The right lower and left pulmonary veins were connected normally to the LA. There was a bridging vein between the left superior caval vein and the RSCV. RA: Right atrium, RV: Right ventricle, RSCV: Right superior caval vein, LA: Left atrium, LSCV: Left superior caval vein, RUPV: Right upper pulmonary veins, RMPV: Right middle pulmonary veins, RLPV: Right lower pulmonary veins, LPV: Left pulmonary veins
case_images: APC-17-77-g003.jpg
case_images: PMC11198935_01_APC-17-77-g003.jpg
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case_images: The right lower and left pulmonary veins were connected normally to the left atrium with a bridging vein between the left and right superior caval veins [Figure 3a and b].
case_images: (a-f) Angiography shows the drainage of the right superior caval vein into the posteriorly placed left atrium (a), with the left superior caval vein draining via the coronary sinus into the right atrium (b). Paired brachiocephalic veins arose from the right internal jugular vein, one closer to the aortic arch and the other at the root of the neck (c). (d through f) the dimensions of the right internal jugular vein at 6.06 mm, the right superior caval vein at 7.44 mm, the lower brachiocephalic vein at 8.34 mm, the left superior caval vein with a width of 12 mm and length of 18 mm, and the azygous vein at 5.3 mm
case_images: APC-17-77-g004.jpg
case_images: PMC11198935_01_APC-17-77-g004.jpg
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case_images: Contrast injection into the right internal jugular vein, however, revealed the presence of two bridging brachiocephalic veins, one closer to the aortic arch and another at the root of the neck lying anterior to the trachea, as well as the drainage pattern of the right and left superior caval veins [Figure 4a-c and Video 2]. The dimensions of the right internal jugular vein, the right superior caval vein, the lower brachiocephalic vein, the left superior caval vein and the azygous vein were determined [Figure 4 d-f].
case_images: (a and b) Follow-up fluoroscopy showing the location of the occluding device relative to the azygous vein, mostly positioned in the orifice of the right superior caval vein (a and b). A venogram taken subsequent to deployment shows no flow into the left atrium (c)
case_images: APC-17-77-g005.jpg
case_images: PMC11198935_01_APC-17-77-g005.jpg
case_images: apc_170_23-f005
case_images: Hence, we positioned a KONAR-MF ventricular septal defect occluder device (Lifetech, Shenzhen, China) partially in the azygous vein but mostly in the right superior caval vein at its junction with the left atrium, avoiding the orifices of the right pulmonary veins [Figure 5a and b]. An angiogram confirmed appropriate placement with no flow from the right caval and azygos veins to the left atrium [Figure 5c].