Venous aneurysms are rare causes of a neck mass. Aneurysm of External Jugular Vein (EJV) is very rare. Surgery is the treatment of choice .Aneurysm of the External Jugular Vein is a very rare clinical entity . The etiology is congenital or acquired . Acquired causes include trauma , tumor , iatrogenic trauma, thoracic outlet syndrome. Imaging techniques include Ultrasonography, Doppler ; rarely Angiography is required . We report a case of EJV aneurysm in a 45 year old lady who presented with history of swelling in the right side of the neck of one year duration and pain of two months duration . She had noticed increase in size of the swelling during coughing and speaking. There was no preceding history of local trauma. Clinical examination showed a 3 cm diameter,soft, non- compressible swelling in the right supraclavicular region. The swelling increased in size on coughing, Valsalva maneuver and speaking. There was no thrill or bruit. Ultrasonography and Doppler study of the area showed an eccentric, well defined, swelling measuring 30 x 13 x 25mm seen arising from the distal part of the right EJV with blood swirling in the swelling. The communication with the EJV was 3mm . CT Angiography confirmed a 30 x 17mm saccular aneurysm of right EJV at C6-C7 level,abutting the right sternocleidomastoid . The aneurysm was excised and the wall of the ETV was reconstructed with a Dacon patch . Post - operative Doppler study did not reveal any flow abnormality in the right EJV. Antiplatelet agent ( Clopidogrel 75 mg once daily ) was continued for six months. Patient is doing fine. Aneurysms of the cervical venous system are rare due to the low pressure in the veins. The Internal jugular vein is rarely involved. EJV aneurysms are extremely rare. The etiology is congenital fragility of the venous wall or acquired. Acquired causes are trauma, tumor, thoracic outlet syndrome, iatrogenic trauma . The aneurysm could be saccular or fusiform. Venous colour Doppler is a useful imaging technique. Computerised Tomagraphy Angiography is the gold standard imaging technique. Surgical excision is the treatment of choice for fear of risk of thrombosis, rupture and for cosmetic reasons .
Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German-board-certified cardiac surgeon with a subspecialization in pediatric cardiac surgery. From 2006-2008, she was the junior consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellowship at the Children's Hospital Boston/USA. From 2009 to 2011 she was director of pediatric cardiac surgery in Mainz/Germany. From 2011-2014 she was senior consultant in children heart center in Linz/Austria. From 2014 she is senior consultant at the University Hospital Munich/Germany and University Lecture of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.
Objectives: The impact of the ventricular morphology in patients, who underwent Fontan procedure on midterm and late outcomes are subjects of controversial discussions in the literature worldwide. The aim of this study was to compare the postoperative outcomes between single left ventricle and single right ventricle morphology referring to the ventricular function and the need of feasible chronic heart failure therapy. Methods: Fontan palliation was performed by 168 Patients with a single ventricle morphology (median age 2.6 years, median weight 12.4 kg, female n=68, 40.2%; male n=101, 59.8%). We aimed to report our results on our hospital in a retrospective and descriptive analysis from 2003 to 2012. Group I: 116 hypoplastic left heart syndrome (HLHS), Group II: hypoplastic right ventricle n=35. We compared the patients by their heart disease in two groups of ventricular morphology. The echocardiogram study of single ventricle function and the necessity of chronic heart failure treatment were compared straight after Fontan procedure and after six, twelve, sixty, 120 and 156 months. Results: Patients with right ventricular morphology had a significant higher need of chronic heart failure therapy pre-Fontan (p=0) and after six (p< 002), twelve (p< 0.04) and sixty months (p< 0.004). Straight after the Fontan procedure and after 10 and 13 years we could not find a significant difference. In group I was performed after Fontan 13 cardiovascular interventions and 8 cardiac reoperations while in group II was reoperations required just in 2 cases. The echocardiogram study of single ventricle function showed no significantly higher occurrence of decreased ventricular function in the groups. One Patient died in group II died 13 years after Fontan operation because of cardiogenic shock. Conclusion: The midterm and late outcome of patients with single left or single right ventricle at our hospital is comparable good and these are comparable with international results. Our results showed that patients with single right ventricle morphology have an increased need of chronic heart failure therapy.