As for the postoperative complications of surgery for substernal goiters, they have been reported to include pneumonia, atelectasis, pneumothorax, pleural effusion, and
innominate vein injuries, etc., which seem to be characteristic complications of mediastinal surgical procedures [16].
First, because of the anatomic findings: our patient presented with an exceptionally infrequent variant of PAPVC, a left-sided aberrant superior pulmonary vein draining into the left
innominate vein. Also, our patient's echocardiogram revealed a large right atrium without an atrial septal defect.
In left sided PAPVC, vertical vein was ligated at junction of
innominate vein and proximal vertical vein was anastomosed with left atrial appendage.
The most common area of lead related fibrotic stenosis is the junction between the superior vena cava and
innominate vein. Thrombosis or stenotic lesions may also occur in the axillary, subclavian and
innominate veins, or in the superior vena cava, and silent lesions have been reported to be relatively common.
On the right side of the neck, the right lymphatic duct conveys the lymph from the head and neck, the upper extremity and the right side of the thorax to the right
innominate vein. Here, the duplicated thoracic duct on the left side opened directly into the inferior vena cava.
During the course of surgery, while the patient's chest was being opened, the
innominate vein was torn.
On the contrary, when the tip was in a different location, such as the
innominate vein or the innominate/SVC junction, incidence of thrombosis was as high as 70%.
Right subclavian vein venography demonstrated the absence of RSVC and drainage of right subclavian vein into the PLSVC via the
innominate vein [Figure 1]a.
This approach offers a longitudinal view of intrathoracic segment of the SCV reaching (via the
innominate vein on left side) the IJV at the level of the Pirogoff confluent.
Second, the
innominate vein and artery were sectioned for safe exposure.
In 80% of cases, there is RSVC and in 35% of cases, the
innominate vein is present.
Then superior vena cava cannulla was placed into the
innominate vein and after bicaval cannulation CPB was initiated.