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Elusive Pulmonary Venous Confluence-to-Hepatic Vein Connection Leading to Heart Failure

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Abstract

A persistent omphalomesenteric vein (POMV) maintaining a link between the pulmonary venous system and the infracardiac hepatic venous system can lead to significant left-to-right shunting. To the best of the authors’ knowledge, POMV causing significant left-to-right shunting has been unreported previously, especially in association with type B interrupted aortic arch. This report describes this association in a child who had chronic heart failure even after successful repair of interrupted aortic arch and ventricular septal defect. Subsequent percutaneous device closure of the POMV using an Amplatzer vascular plug II led to resolution of the child’s heart failure.

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Authors and Affiliations

  1. Department of Paediatric Cardiology, Royal Hospital, Post Box 1331, Muscat, 111, Oman

    Eapen Thomas, Salim Maskari & Abdullah Farqani

  2. Department of Radiology, Royal Hospital, Post Box 1331, Muscat, 111, Oman

    Sheikha Al Balushi

Authors
  1. Eapen Thomas
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  2. Salim Maskari
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  3. Abdullah Farqani
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  4. Sheikha Al Balushi
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Corresponding author

Correspondence to Eapen Thomas.

Electronic supplementary material

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246_2012_605_MOESM1_ESM.mp4

Movie clip 1 Follow-through anteroposterior view of the left pulmonary arteriogram demonstrating the omphalomesenteric vein connecting the left pulmonary venous confluence to the left hepatic vein, which in turn drains into the inferior vena cava. (MP4 1417 kb)

246_2012_605_MOESM2_ESM.mp4

Movie clip 2 Straight lateral view of the same angiogram as in clip 1 demonstrating the omphalomesenteric vein connecting from the anteroinferior aspect of the left pulmonary venous confluence to the left hepatic vein. (MP4 1437 kb)

246_2012_605_MOESM3_ESM.mp4

Movie clip 3 Complete occlusion of the omphalomesenteric vein by the Amplatzer vascular plug as demonstrated by the hand injection angiogram via the sheath used to deploy the device. (MP4 550 kb)

246_2012_605_MOESM4_ESM.mp4

Movie clip 4 Straight lateral view of the left pulmonary artery angiogram after the device release showing the complete occlusion of the omphalomesenteric vein by the optimally positioned Amplatzer vascular plug. (MP4 1529 kb)

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Thomas, E., Maskari, S., Farqani, A. et al. Elusive Pulmonary Venous Confluence-to-Hepatic Vein Connection Leading to Heart Failure. Pediatr Cardiol 34, 2052–2055 (2013). https://doi.org/10.1007/s00246-012-0605-0

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  • DOI: https://doi.org/10.1007/s00246-012-0605-0

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