To describe the prenatal ultrasound characteristics of persistent left superior vena cava (PLSVC) in fetuses and its correlation with related malformations, chromosomal abnormalities, and clinical outcomes. A 10-year retrospective analysis of the clinical and ultrasound data of 898 fetuses diagnosed with PLSVC at our center was conducted. Ultrasound characteristics of PLSVC type were summarised systematically, and incidence rates of abnormalities and pregnancy outcomes of PLSVC types were determined. Diagnosing PLSVC requires the 4CV, 3VV and 3VT views, while auxiliary classification requires parasagittal and innominate vein views. PLSVC ultrasound features include coronary sinus dilation and an additional vascular cross-section on the left side of the pulmonary artery. Types I and II PLSVC involved 94.2% vs. 5.8% of cases, respectively. Type I PLSVC had lower incidence of abnormalities (70.3%) than Type II (100%; p < 0.001) and higher birth rates (63.5% vs. 7.7%; p < 0.001). However, they differed non-significantly in incidence of chromosomal abnormalities (p > 0.05). Of fetuses, 28.0 and 72.0% had isolated and non-isolated PLSVC, respectively. Lower incidence of chromosomal abnormalities occurred in fetuses with isolated PLSVC (7.8%) than that in non-isolated PLSVC (22.0%; p < 0.05). Among the non-isolated group, the subgroup with coexisting cardiac and extracardiac abnormalities had the highest incidence of chromosomal abnormalities (39.5%; p < 0.005). Higher live birth rate occurred for fetuses with isolated PLSVC (99.2%) than for non-isolated PLSVC (45.1%; p < 0.001). Multifaceted prenatal ultrasound is valuable for classifying and categorizing fetal PLSVC. Classifying PLSVC and assessing accompanying abnormalities is key to determining prognosis. Type II or non-isolated PLSVC, when accompanied by intracardiac and extracardiac abnormalities, requires enhanced genetic testing and multidisciplinary management. Contrariwise, Type I or isolated PLSVC has good prognosis.

This case report describes a successful dextrocardia-preserving orthotopic heart transplant in a patient with situs inversus totalis and an extracardiac Fontan, utilizing a levocardia donor heart. The donor heart was rotated 90° counterclockwise along its longitudinal axis to optimize inferior venous connection and incorporate existing extracardiac Fontan. Superior venous connections were secured using a harvesting technique preserving the innominate vein. A GORE-TEX graft was wrapped around the innominate vein to prevent its compression as it passed through the aortic arch. Counterclockwise rotation requires adequate pulmonary artery length. In the absence of extra aortic tissue to allow mild aortic bowing and prevent superior venous obstruction, a GORE-TEX graft offers an effective alternative to maintain unobstructed superior venous drainage. Dextrocardia-preserving transplantation is feasible with a 90° counterclockwise rotation. Reusing the extracardiac Fontan reduces ischemic time; reinforcing the innominate vein with GORE-TEX prevents compression, securing venous integrity.

Thymic mucinous adenocarcinoma is an extremely rare and aggressive malignant tumor of the thymus with a very low 5-year survival rate. Here, we report a case of surgically resected primary mucinous adenocarcinoma of the thymus in a patient in his 60s who was admitted to the hospital with chest tightness for 2 weeks. The patient underwent median sternotomy and thymectomy, including resection of the brachiocephalic vein and partial resection of the superior vena cava wall. Histopathologic examination confirmed the diagnosis of mucinous adenocarcinoma, staged as pT2aN2M0 (IVB). Immunohistochemical analysis showed negative expression of CK20 and CK7, and preoperative carcinoembryonic antigen levels were within the normal range.

The axillary and cephalic veins are commonly utilized for transvenous pacemaker lead access. They typically advance to the heart through the subclavian, brachiocephalic, and superior vena cava veins. Anatomical variations such as a persistent left superior vena cava (PLSVC) may pose a challenge, necessitating an alternative approach for lead placement. This anomaly can often be identified during venographic contrast imaging or by visualizing atypical venous courses during the procedure. Another challenge occurs when the venous pathway is tortuous. Careful monitoring during the procedure is crucial to ensure that the lead follows the intended path. If not, the lead may inadvertently enter a collateral, such as the inferior thyroid vein, which drains into the internal jugular or left brachiocephalic vein. Despite these deviations, the lead may eventually reach the heart, although via an unusual course. If such a lead is left in place, even in the absence of immediate complications, long-term outcomes are unpredictable and carry the risk of unforeseen complications.

To evaluate the technical feasibility and safety of a reentry device for endovascular recanalization of central venous occlusions associated with dysfunctional arteriovenous fistulas. Between January 2013 and December 2023, 20 patients (13 women; mean age, 61.1 years) with dysfunctional fistulas attributed to central venous occlusion underwent treatment using an Outback LTD reentry device. All patients had experienced unsuccessful recanalization attempts using conventional endovascular techniques. Symptoms included increased venous pressure during hemodialysis (N = 8), arm swelling (N = 8), absence of flow (N = 1), graft thrombosis (N = 2), and maturation failure (N = 1). The mean age of the fistulas was 56.1 months, and 11 patients had a history of angioplasty. An Outback LTD reentry device was used when conventional endovascular techniques were unsuccessful. Occlusions were observed at the junction of the subclavian and innominate veins (N = 15) and in the right innominate vein (N = 2), subclavian vein (N = 1), and axillary vein of the arm (N = 2). The reentry device was introduced via the fistula (N = 11), femoral vein (N = 8), or internal jugular vein (N = 1). Technical success was achieved in 18 patients (90.0%), all of whom successfully underwent hemodialysis. Eight patients with arm swelling experienced symptom relief. In the 14 patients available for long-term follow-up, the mean intervention-free period was 5.0 months, and the mean functional period of the fistula, with or without subsequent endovascular treatment, was 23.0 months. No complications were observed. An Outback reentry device may be used for central venous occlusions when conventional techniques are unsuccessful.