Anomalies of the systemic venous return.

Anomalies in the course and drainage of systemic veins, in particular the inferior vena cava, markedly complicate or even prevent cardiac catheterization and some surgical procedures. Such anomalies have been observed in 32 out of 1,266 children subjected to catheterization and angiocardiography, i.e. 2.5 per cent. Severe anomalies of a superior vena cava were observed in six children, one of them having an associated anomaly of an inferior vena cava. Anomalies of the inferior vena cava were observed in 27 children. The latter included persistent paired development of the inferior vena cava, aplasia of suprarenal portion with azygos or hemiazygos continuation, its persistence at the side of the cardiac apex and combination of these findings. In 19 of the children with an anomaly of the inferior vena cava there was a visceral situs indeterminatus associated, often with severe congenital heart disease and with a large intracardiac shunt (e.g. transposition of the great arteries and stenosis or atresia of the pulmonary artery). Suspicious of such combinations of visceral situs indeterminatus with anomalies of the inferior vena cava and severe congenital heart disease can be suspected on plain chest films, but the diagnosis can be definitely determined only by angiocardiography.