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1.  Treatment of obstruction of the superior vena cava by combination chemotherapy with and without irradiation in small-cell carcinoma of the bronchus. 
Thorax  1983;38(7):501-505.
In a randomised prospective trial of chemotherapy with and without radiotherapy in small-cell carcinoma of the bronchus, 37 of 366 patients presented with obstruction of the superior vena cava at the time of diagnosis. In the study all patients received four cycles of combination chemotherapy over a period of 12 weeks and, provided there was not progressive disease, then received either radiotherapy to the mediastinum and primary tumour followed by eight further courses of chemotherapy or eight cycles of chemotherapy alone. Of the 37 patients presenting with superior vena caval obstruction, nine had relapsed and treatment was stopped during or after the initial four cycles of chemotherapy. Of the remainder, 15 patients received radiotherapy plus chemotherapy and 13 chemotherapy alone. After four cycles of chemotherapy (12 weeks) 21 of the 37 patients had initial complete relief of symptoms secondary to superior vena caval obstruction, 10 had substantial but partial relief, and six had no relief. Twelve patients developed recurrence of superior vena caval obstruction, of whom six had received radiotherapy and four chemotherapy alone; two relapsed in the initial 12 weeks of the study. The median survival of the patients with superior vena caval obstruction allocated at diagnosis to either treatment arm was identical. The survival of patients with obstruction was similar to that of other patients in the main study. Chemotherapy is an effective treatment for superior vena caval obstruction and there appears to be no additional advantage in giving radiotherapy after 12 weeks of cyclical chemotherapy.
PMCID: PMC459595  PMID: 6310812
2.  Surgical repair of tricuspid atresia 
Thorax  1971;26(3):240-248.
Surgical repair of tricuspid atresia has been carried out in three patients; two of these operations have been successful. A new surgical procedure has been used which transmits the whole vena caval blood to the lungs, while only oxygenated blood returns to the left heart. The right atrium is, in this way, `ventriclized', to direct the inferior vena caval blood to the left lung, the right pulmonary artery receiving the superior vena caval blood through a cava-pulmonary anastomosis. This technique depends on the size of the pulmonary arteries, which must be large enough and at sufficiently low pressure to allow a cava-pulmonary anastomosis. The indications for this procedure apply only to children sufficiently well developed. Younger children or those whose pulmonary arteries are too small should be treated by palliative surgical procedures.
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PMCID: PMC1019078  PMID: 5089489
3.  Intimal sarcoma of the superior vena cava. 
Postgraduate Medical Journal  1993;69(808):155-156.
A case of superior vena cava syndrome caused by a primary intimal sarcoma of the superior vena cava is described. The known causes of superior vena caval obstruction are discussed, together with the difficulties in identifying the underlying lesion. The possibility of a primary superior vena caval neoplasm as a cause of superior vena caval obstruction should be considered in patients presenting with superior vena caval syndrome.
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PMCID: PMC2399625  PMID: 8506202
4.  Superior vena cava syndrome secondary to thyroid cancer 
It is uncommon for thyroid cancer to present with superior vena cava syndrome. Obstruction of superior vena cava can develop as a result of intrinsic and extrinsic spread of the thyroid cancer. The usual presentation of this disease entity is a neck mass with symptoms and signs suggestive of superior vena cava obstruction. Superior vena cava obstruction is commonly caused by lung cancer and lymphoma. However, thyroid cancer can cause superior vena cava obstruction by downward tumour spread into the mediastinum causing extrinsic compression, which will lead to narrowing and thrombosis of the major venous system in the chest. Paraganglioma can also present with superior vena cava obstruction and it mimics thyroid cancer microscopically. Proper staining should be performed to differentiate between the two diseases. This could be the first case of this kind reported in the literature.
doi:10.1093/jscr/2011.7.7
PMCID: PMC3649273
5.  Expandable Wallstent for the treatment of obstruction of the superior vena cava. 
Thorax  1993;48(9):915-920.
BACKGROUND--Palliative treatments for obstruction of the superior vena cava all have disadvantages. The use of a fine braided wire self expanding stent (Wallstent, Schneider (Europe) AG) in patients with malignant and benign causes of superior vena cava obstruction is reported. METHODS--Five patients with obstruction of the superior vena cava were treated with balloon angioplasty of the stricture and the percutaneous insertion of an expandable Wallstent endoprosthesis across the site of the stricture. Four patients had advanced mediastinal malignancy previously treated by radiotherapy and one patient had fibrosing mediastinitis. RESULTS--All patients experienced rapid symptomatic relief and, in three cases, complete palliation was achieved during survival times of seven weeks, nine weeks, and 24 weeks, respectively. Two surviving patients (with a recurrent thymoma and fibrosing mediastinitis) were free of symptoms when followed up at eight and nine months respectively. CONCLUSIONS--Initial experience with the Wallstent endoprosthesis suggests that it is a valuable treatment alternative once conventional therapy has failed and gives rapid relief of symptoms to patients with obstruction of the superior vena cava.
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PMCID: PMC464777  PMID: 7694384
6.  AB 58. The current role of 3-D conformal radiotherapy in syndrome of vena superior. The experience in University General Hospital of Thessaloniki, AHEPA 
Journal of Thoracic Disease  2012;4(Suppl 1):AB58.
Background
The syndrome of Vena Cava Superior (SVCS) usually is caused from tumor-mass of lung cancer, which blockage the vena cava superior. It appears with swelling in face, redness, and dyspnoea. It is an urgent condition in medical clinical Oncology and demands urgently external beam radiotherapy. The immediately current role of 3D conformal external radiotherapy in Syndrome of Vena Cava Superior.
Patients and methods
A total of 16 patients with lung cancer and Syndrome of Vena Cava superior came in Department of Radiation therapy in U.G.H.TH.AHEPA, in the period 2010-2012. 6 patients revealed acute symptoms (swelling, dyspnoea). A total of 10 patients revealed incipient Syndrome of vena cava superior. Computered Tomography of Thorax showed tumor mass which caused blockage in the vena cava superior, in all of the patients. It has been made biopsy and it was excluded the diagnosis of Lymphoma or tumor of genital cells. All of the patients were submitted immediately in CT-Simulator equation, 2D-3D Conformal Treatment Planning with linear accelerator with MLC-multilief Collimator (blocks for protection the organs at risk (OAR)-heart, spinal cord, unilateral lung. Patients with incipient Syndrome received 10 fractions with 300 cGy/fraction in two weeks (3.000 cGy). Patients with already installed Syndrome V.C.S. (with acute symptoms) received in the first two fractions 400 cGy/fraction and they continued with 6 fractions with 300 cGy/fraction. Total dose was 2.600 cGy.
Results
Patients were rehabilitated their respiratory function after the second fraction. Swelling and redness in the face did not appear after third fraction. A total of 14 patients after the end of radiotherapy were in excellent performance status. In 2 patients the minimal dyspnoea disappeared two weeks after the end of radiotherapy. One month after the end of radiotherapy the CT of thorax showed reduce of the tumor mass. Respiratory function was in complete rehabilitation.
Conclusions
The immediately urgently external beam radiotherapy, in a few days and high dose, compose an excellent therapeutical approach for the patients with Syndrome of Vena Cava Superior. Relieves from the symptoms in patients, increasing their overall survive and give improvement in the quality of life.
doi:10.3978/j.issn.2072-1439.2012.s058
PMCID: PMC3537351
7.  Surgical management of tricuspid atresia 
Thorax  1969;24(2):239-245.
Tricuspid atresia is one of the less common forms of congenital heart disease. The results of palliative surgery in 72 children are presented. Cardiac catheterization and angiocardiography are essential for precise definition of the anomaly. There is a 20% incidence of obstruction at atrial septal level. Closed atrial septostomy is of value in such cases in infancy. In most there is a reduced pulmonary blood flow. This may be increased by anastomosis of either the superior vena cava or a systemic artery to the pulmonary artery. The caval anastomosis, while having theoretical advantages, is not always possible, especially in small infants. In this series systemic arterial shunts have given at least comparable results, suggesting that both techniques are of value with this anomaly.
PMCID: PMC471945  PMID: 5821626
8.  Transcaval repair of sinus venosus defect. Using a butterfly-shaped patch. 
Texas Heart Institute Journal  1995;22(4):304-307.
We describe an operative technique used in 30 patients from 1982 to 1995, in which sinus venosus atrial septal defect with anomalous pulmonary venous connection is repaired through longitudinal incision confined to the vena cava. A single oval patch is folded like the wings of a butterfly: the posterior wing is used to separate superior vena caval and pulmonary venous blood, and the anterior wing is used to enlarge the terminal cava. This approach avoids both sinus node dysfunction and superior vena caval or pulmonary venous obstruction. Operative findings suggest that the sinus venosus defect is a malformation involving abnormal confluence of sinus venosus, anomalous right superior pulmonary, and right common cardinal veins. Further, the sinus venosus contributes more to the formation of the right atrium, displacing the crista terminalis downward and forward and separating the atrial component of the right atrium from the terminal cava.
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PMCID: PMC325278  PMID: 8605430
9.  Superior mediastinal obstruction with aortic dissection after aortic valve replacement. Diagnosis by computed tomography. 
British Heart Journal  1984;51(5):565-567.
In two patients aortic dissection occurred as a late complication of aortic valve replacement and caused superior vena caval obstruction. The dissection and superior vena caval obstruction were diagnosed by computed tomography.
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PMCID: PMC481549  PMID: 6721951
10.  Superior vena caval stenosis: a complication of transvenous endocardial pacing. 
Thorax  1979;34(3):412-413.
Superior vena caval obstruction is a rare complication of transvenous endocardial pacing and is usually the result of thrombus formation round the pacing electrode (Kosowsky and Barr, 1972). We report a case of superior vena caval obstruction without thrombus formation secondary to localised stenosis at the site of the proximal cut end of a retracted endocardial electrode. This complication of transvenous pacing electrodes has not been described previously.
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PMCID: PMC471088  PMID: 483222
11.  Surgical treatment of idiopathic mediastinal fibrosis: report of five cases. 
Thorax  1986;41(3):210-214.
Idiopathic mediastinal fibrosis is a rare disease of unknown aetiology. It is a benign condition in which abnormal proliferation of fibrous tissue occurs within the mediastinum, leading to constriction and obliteration of local structures, particularly the great veins. It is a rare cause of superior vena caval obstruction (1-2%) but one that is potentially amenable to surgical palliation. The results of venous reconstruction in five patients with superior vena caval obstruction secondary to idiopathic mediastinal fibrosis are reported. Reversed autogenous saphenous vein grafts were used in two patients, woven silicone rubber prostheses in two, and bovine pericardial conduits in one patient. Useful long term results were obtained in three patients, but the bovine pericardial graft and one of the vein grafts failed within a few weeks.
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PMCID: PMC460296  PMID: 3715778
12.  Radiation-induced superior vena cava syndrome. 
Texas Heart Institute Journal  1995;22(1):103-104.
A 59-year-old man developed superior vena caval obstruction 20 years after receiving a radiation treatment for primary germinal cell tumor of the mediastinum. Venous decompression was achieved by anastomosing a 10-mm ringed polytetrafluoroethylene graft from the left internal jugular vein to the right atrium, which yielded immediate relief of symptoms. A left internal jugular venogram demonstrated graft patency 11 months post-operatively, and the patient remained free of symptoms of superior vena caval obstruction 29 months postoperatively.
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PMCID: PMC325220  PMID: 7787461
13.  Jugular venous `a' wave in pulmonary hypertension: new insights from a Doppler echocardiographic study 
British Heart Journal  1992;68(2):187-191.
Objective—To study the mechanisms underlying the dominant `a' wave seen in patients with primary pulmonary hypertension.
Design—Retrospective and prospective examination of the jugular venous pulse recording, flow in the superior vena cava, and Doppler echocardiographic studies.
Setting—A tertiary referral centre for both cardiac and pulmonary disease, with facilities for invasive and noninvasive investigation, and assessment for heart and heart-lung transplantation.
Patients—12 patients with primary pulmonary hypertension, most being considered for heart-lung transplantation.
Results—Two distinct patterns of venous pulse and superior vena caval flow were identified: a dominant `a' wave with no `v' wave, an absent or poorly developed `y' descent, and exclusively systolic downward flow in the superior vena cava (group 1, n = 8), and a dominant `v' wave, deep `y' descent and exclusively diastolic downward flow in the superior vena cava (group 2, n = 4). A comparison between the two groups showed age (mean (SD)) 42 (18) ν 36 (7) years, RR interval 700 (65) ν 740 (240) ms, left ventricular end diastolic dimension 3·6 (0·8) ν 3·2 (1·0) cm and end systolic dimension 2·1 (0·5) ν 2·3 (0·3) cm, right ventricular end diastolic dimension 2·6 (0·5) ν 2·8 (0·6) cm, and pressure drop between right ventricle and right atrium 60 (8) ν 70 (34) mm Hg to be similar. Duration of tricuspid regurgitation 520 (30) ν 420 (130) ms and the time interval of pulmonary closure to the end of the tricuspid regurgitant signal 140 (30) ν 110 (40) ms were longer in group 1 compared with group 2, whereas right ventricular filling time was much shorter 180 (70) ν 350 (130) ms. In seven patients from group 1, a single peak of forward tricuspid flow was present, but this pattern was seen in only one patient from group 2.
Conclusions—In patients with primary pulmonary hypertension, the apparent `a' wave seen in the venous pulse is, in fact, a summation wave. It is probably the result of large pressure changes that must underlie rapid acceleration and deceleration of blood across the tricuspid valve when the right ventricular filling time is short.
PMCID: PMC1025012  PMID: 1389735
14.  A case of pacing lead induced clinical superior vena cava syndrome: a case report 
Cases Journal  2009;2:7477.
Introduction
Transvenous pacing is a relatively safe treatment with a low complication rate, but serious thromboembolic complications have been reported to occur in 0.6% to 3.5% of cases. Superior vena cava obstruction syndrome is generally an uncommon but serious complication occurring in <0.1% of patients. However, when it occurs it carries with it significant morbidity and mortality.
Case presentation
A 51-year-old lady with long history of DDD permanent pacemaker presented following a mechanical fall. She had no obvious injuries, and was hemodynamically stable. General examination revealed features suggestive of Superior vena caval obstruction which was later confirmed by imaging. She was treated with long term oral anticoagulation with good clinical improvement.
Conclusion
Superior vena cava obstruction in patients with transvenous pacing leads, although rare, is a well recognized complication. With growing elderly population and increasing number of procedures performed, more and more people with permanent pacemaker are likely to be encountered in clinical practice. One should carefully look for thromboembolic complications during follow-up in patients with transvenous pacemaker leads, as it has implications for future management and carries significant morbidity and mortality.
doi:10.4076/1757-1626-2-7477
PMCID: PMC2740201  PMID: 19829974
15.  The Role of Corticosteroids in the Treatment of Pain in Cancer Patients 
Current Pain and Headache Reports  2012;16(4):307-313.
Pain is one of the most frequent and most distressing symptoms in the course of cancer. The management of pain in cancer patients is based on the concept of the World Health Organization (WHO) analgesic ladder and was recently updated with the EAPC (European Association for Palliative Care) recommendations. Cancer pain may be relieved effectively with opioids administered alone or in combination with adjuvant analgesics. Corticosteroids are commonly used adjuvant analgesics and play an important role in neuropathic and bone pain treatment. However, in spite of the common use of corticosteroids, there is limited scientific evidence demonstrating their efficacy in cancer patients with pain. The use of corticosteroids in spinal cord compression, superior vena cava obstruction, raised intracranial pressure, and bowel obstruction is better established than in other nonspecific indications. This review aims to present the role of steroids in pain and management of other symptoms in cancer patients according to the available data, and discusses practical aspects of steroid use.
doi:10.1007/s11916-012-0273-z
PMCID: PMC3395343  PMID: 22644902
Adjuvant analgesics; Cancer; Corticosteroids; Opioids; Pain
16.  Surgical management of superior vena cava syndrome after failed endovascular stenting 
The superior vena cava syndrome encompasses a constellation of symptoms and signs resulting from obstruction of the superior vena cava. We report a successful surgical management after failed endovascular stenting for superior vena cava syndrome, caused by a postradiation fibrosis after conventional radiotherapy for breast cancer. We emphasize the rarity of this uncommon surgical procedure and the bailout procedure for failed angioplasty and intravascular stenting. Key points of superior vena cava syndrome and its management are discussed.
doi:10.1093/icvts/ivs316
PMCID: PMC3480597  PMID: 22843656
Superior vena cava stents; Radiation therapy; Endovascular stents; Surgery
17.  Cardiovascular complications of parenteral nutrition. 
Postgraduate Medical Journal  1992;68(802):629-633.
During a 3 year period, 1987-1989, we encountered three major complications associated with parenteral nutrition leading to congestive cardiac failure--acute beriberi, right atrial and superior vena caval thrombosis, and fungal endocarditis. Unrecognized, these are invariably fatal. Persistent vomiting from intestinal obstruction led to the development of thiamine deficiency in the patient with beriberi. Recurrent catheter tip sepsis probably accounted for thrombosis and endocarditis in the second and third cases, respectively. These conditions are preventable with careful attention to nutritional replenishment and aseptic technique. In patients with catheter-related sepsis early, repeated blood culture is of diagnostic value. Patients with Staphylococcus aureus catheter-associated bacteraemia require at least 4 weeks of appropriate antibiotic therapy. Recurrent sepsis, especially when associated with pulmonary embolic phenomena, is an indication for echocardiography.
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PMCID: PMC2399567  PMID: 1448402
18.  Cardiac involvement and superior vena caval obstruction in Behçet's disease. 
Thorax  1978;33(3):375-377.
A patient with Behçet's disease developed the rare complications of pericarditis and, two months later, superior vena caval obstruction. The latter complication was investigated by angiography to exclude other causes. As a result of this investigation the caval obstruction was managed conservatively, the symptoms and signs improving spontaneously.
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PMCID: PMC470899  PMID: 684675
19.  Primary Pulmonary Artery Sarcoma Extending Retrograde into the Superior Vena Cava 
Texas Heart Institute Journal  2011;38(1):77-80.
Primary pulmonary artery sarcoma is a rare tumor that is highly fatal. It can be misdiagnosed as acute or chronic pulmonary thromboembolic disease. Herein, we report the case of a 22-year-old woman with a preoperative diagnosis of pulmonary embolism and superior vena caval thrombosis. Intraoperatively, an extensive sarcoma was seen to extend retrograde from the pulmonary artery, past the right ventricle and right atrium, and into the superior vena cava. Surgical resection of the tumor and reconstruction of the central pulmonary arteries, followed by adjuvant chemotherapy, relieved the clinical symptoms. The patient remained free of cancer at 14 months postoperatively. We believe that this is the 1st report of a primary pulmonary artery sarcoma that extended retrograde into the superior vena cava.
PMCID: PMC3060731  PMID: 21423477
Chemotherapy, adjuvant; diagnosis, differential; diagnostic imaging; echocardiography, transesophageal; neoplasms, vascular tissue/diagnosis/physiopathology/surgery; pulmonary artery/pathology/radiography; sarcoma/diagnosis/physiopathology/radiography/surgery; treatment outcome; vena cava, superior/pathology
20.  Localized idiopathic fibrosing mediastinitis as a cause of superior vena cava syndrome: a case report 
Canadian Journal of Surgery  1998;41(1):68-71.
An unusual case of superior vena cava syndrome, caused by localized fibrosing mediastinitis is presented. A 41-year-old woman had swelling of the face and upper extremities, associated with headache and fatigue. Radiologic investigations, which included venography, computed tomography and magnetic resonance imaging of the chest, documented the presence of superior vena caval (SVC) obstruction secondary to what appeared to be an intraluminal tumour. The patient underwent SVC resection and reconstruction with a spiral saphenous vein graft under cardiopulmonary bypass and deep hypothermic circulatory arrest. On histopathological examination localized idiopathic fibrosing mediastinitis causing SVC obstruction was diagnosed.
PMCID: PMC3950064  PMID: 9492750
21.  Superior vena cava obstruction caused by radiation induced venous fibrosis 
Thorax  2000;55(3):245-246.
Superior vena cava syndrome is most often caused by lung carcinoma. Two cases are described in whom venous obstruction in the superior mediastinum was caused by local vascular fibrosis due to radiotherapy five and seven years earlier. The development of radiation injury to greater vessels is discussed, together with the possibilities for treatment of superior vena cava syndrome.


doi:10.1136/thorax.55.3.245
PMCID: PMC1745707  PMID: 10679546
22.  Caval umbrella causing obstructive uropathy. 
Postgraduate Medical Journal  1996;72(846):235-237.
A 49-year-old woman had a vena caval filters inserted having suffered multiple pulmonary emboli and a large upper gastrointestinal bleed. She re-presented five years later with loin pain and obstructive uropathy. She was found to have a right pelvi-ureteric obstruction due to inferior vena caval wall perforation from the vena caval filter.
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PMCID: PMC2398432  PMID: 8733535
23.  Superior vena cava syndrome due to metastasis from urothelial cancer: A case report and literature review 
Urology Annals  2013;5(4):291-293.
Superior vena cava (SVC) syndrome is caused by compression or obstruction of the SVC. We report here in a case of SVC syndrome due to lymph node metastasis from urothelial cancer to the mediastinum and lung. The origin of metastasis was determined by computed tomography (CT)-guided biopsy of metastases. After radiotherapy to the mediastinum with glucocorticoid failed, anticancer pharmacotherapy including paclitaxel, gemicitabine, and cisplatin proved effective and SVC syndrome resolved. But patient died from cerebral bleeding from newer brain metastases 10 months later.
doi:10.4103/0974-7796.120313
PMCID: PMC3835992  PMID: 24311914
Metastatic urothelial cancer; Superior vena cava syndrome; urothelial cancer
24.  Proximal tubular function in dogs with thoracic caval constriction 
Journal of Clinical Investigation  1971;50(10):2150-2158.
The effect of saline infusion on proximal sodium reabsorption was compared in normal dogs and in dogs with acute or chronic partial thoracic vena cava obstruction. After acute vena cava obstruction, proximal fractional sodium reabsorption rose by 74%. During continued caval obstruction, saline loading strikingly reduced proximal reabsorption but sodium excretion remained minimal. In chronic caval dogs, saline loading reduced proximal fractional sodium reabsorption by 31% but sodium excretion in the micropunctured kidney was only 41 μEq/min. After saline infusion in normal dogs, proximal fractional sodium reabsorption fell 39% while unilateral sodium excretion rose to 584 μEq/min.
Nephron filtration rate was also measured before and after saline loading in normal and chronic caval dogs in both repunctured and fresh tubules. There was a marked increase in nephron filtration rate in repunctured tubules and no change in freshly punctured tubules in both groups. The effect of saline loading on nephron filtration rate in normal and chronic caval dogs was similar, therefore, whether repunctured or fresh nephrons were considered.
We conclude that saline infusion depresses proximal sodium reabsorption in acute and chronic TVC dogs. Since saline loading markedly increases distal delivery without a concomitant natriuresis, enhanced distal reabsorption must play a major role in the sodium retention exhibited by chronic caval dogs. Redistribution of filtrate does not appear to be a factor in this sodium retention.
PMCID: PMC292149  PMID: 5116206
25.  Differential atrial filling after Mustard and Senning repairs. Detection by transcutaneous Doppler ultrasound. 
British Heart Journal  1980;44(6):692-698.
The dominance of Mustard's operation for transposition of the great arteries has been challenged by the recent revival of Senning's repair because it promises better long-term results in terms of venous obstruction and atrial haemodynamics. These hypotheses were tested by recording jugular venous flow waveforms transcutaneously in 24 postoperative patients with simple complete transposition using a bidirectional Doppler blood velocimeter. Eight patients had undergone Mustard's operation and 16 the Senning alternative; all had previously had a postoperative cardiac catheterisation. Both groups of patients had similar left ventricular, pulmonary arterial, and systemic venous atrial pressures. No child showed any evidence at catheterisation of either mitral regurgitation or of superior vena caval pathway obstruction. These two findings were endorsed by the transcutaneous Doppler recordings. Jugular venous flow in normal children exhibits two maxima, one of atrial filling during ventricular systole, the other of ventricular filling occurs once the tricuspid valve has opened. Both operative procedures diminished the size of the former phase, but the Mustard did so more. After Mustard's operation forward flow during the atrial filling phase was absent in approximately half the cardiac cycles recorded, and severely diminished in the rest. By contrast, there was approximately a 90 per cent appearance of atrial filling waves after Senning's operation which also provided significantly better atrial function than Mustard's procedure in terms of peak velocity of blood entering the atrium and total atrial filling. It is therefore concluded that both procedures compromise atrial volume and compliance but Senning's repair to a much lesser extent.
PMCID: PMC482467  PMID: 7459153

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