UNASSIGNED: Congenital thoracic venous anomalies (CTVAs) with right-to-left shunt constitute an uncommon source of paradoxical embolization in adults. We present a case of a healthy and physically fit individual with a rare asymptomatic anomaly first presenting with brain abscesses after a visit to the dental office; persistent left superior vena cavae (PLSVC) without bridging vein, over-riding right-sided superior vena cavae (RSVC) connected to the left atrium (LA), and an extracardiac sinus venosus defect.
UNASSIGNED: A 29-year-old male presented to the neurosurgical unit due to intracranial abscesses requiring intervention following a visit to his dentist. The abscess cultures isolated bacteria commonly found in the normal oral flora. Transthoracic echocardiography revealed an enlarged coronary sinus consistent with PLSVC. An agitated saline study was performed and raised suspicion of simultaneous extra- and intracardiac shunting. Magnetic resonance angiography confirmed the presence of a PLSVC and revealed an RSVC connected to the LA; however, no intracardiac shunt was evident. Electrocardiogram-gated computed tomography was therefore conducted and discovered the rudimentary remains of the physiologic RSVC forming a connection to the right atrium, explaining the bilateral contrast loading seen on the agitated saline study and diagnosing an extracardiac sinus venosus defect (SVD). The patient recovered and has been referred for surgery.
UNASSIGNED: This case illustrates a CTVA and a forme fruste type SVD resulting in a severe complication in a healthy adult. We highlight the diagnostic challenges posed, suggest early usage of agitated saline studies, and discuss the rationale for surgical correction of this patient.

Sinus venosus atrial septal defect (ASD) accounts for 5% to 10% of ASDs. In contrast with the more common superior vena cava (SVC) type, the inferior vena cava (IVC) type of sinus venosus ASD with overriding IVC is extremely rare. The sinus venosus defect occur posterior to the fossa ovalis and is not regarded as true ASD. Transesophageal echocardiography (TEE) is a diagnostic procedure of choice due to close proximity of atrial septum to TEE transducer. However; it may not constantly yield detailed anatomical and functional characterization, and other imaging modalities such as cardiac magnetic resonance imaging (MRI) may be needed. We report the case of a 45-year-old woman with an undiagnosed hemodynamically significant IVC-type ASD without any anomalous drainage of pulmonary veins, who presented with progressive dyspnea.

UNASSIGNED: Isolated partial anomalous pulmonary venous return (PAPVR) with intact atrial septum is a rare finding. A cavopulmonary window is a side-to-side veno-venous communication of the right upper pulmonary vein with the superior vena cava which in its course retains connection to the left atrium.
UNASSIGNED: We present a case of this unusual variant of a sinus venosus defect far from the atrial roof. Haemodynamic significance of the shunt was confirmed by enlargement of right heart cavities, elevation of pulmonary artery pressure, and significant left-to-right shunting using multimodality cardiac imaging (transoesophageal echocardiography, cardiac magnetic resonance imaging, and right heart catheterization). The defect has been successfully repaired using minimally invasive axillary thoracotomy.
UNASSIGNED: Partial anomalous pulmonary venous return prevalence is low and about 0.4-0.7% in autopsy series of patients with congenital heart disease. This patient\'s unusual variant of a sinus venosus defect with a window between a pulmonary vein and the superior vena cava far from the atrial roof shows that a sinus venosus defect is not a true atrial septum defect. Left-to-right shunting generally increases with age. Usually, surgical treatment is considered in cases of significant left-to-right shunt (Q p:Q s > 1.5-2.0) and right heart dilatation.

We report the multidisciplinary consideration in a case of right superior vena cava draining into the left atrial roof. A 12-year-old boy was diagnosed with a sinus venosus-type atrial septal defect associated with anomalous right upper pulmonary venous return. However, intraoperative inspection showed the right superior vena cava draining into the left atrial roof, associated with anomalous right upper pulmonary venous return. An anatomical radical operation was performed using a modified conventional technique.