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Veno-venous bridges: the forerunners of the sinus venosus defect

  • Ryan J. Butts (a1), Andrew M. Crean (a2) (a3), Anthony M. Hlavacek (a1), Diane E. Spicer (a4) (a5), Andrew C. Cook (a6), Erwin N. Oechslin (a2) (a3) and Robert H. Anderson (a1) (a6)...

Differentiation of the so-called sinus venosus defect from other defects permitting shunting between the atrial chambers remains problematic. The lesion is not a true septal defect, and current theories to explain the existence of the sinus venosus defect fall short. The presence of persistent systemic to pulmonary venous connections has been proposed to explain the existence of the sinus venosus defect.


Clinical histories and radiological findings of six patients are reviewed. Three patients have veno-venous bridges, two have partial anomalous pulmonary venous connections, and one patient has a sinus venosus defect. The clinical information is reviewed, along with current developmental and morphological considerations.


We provide radiographic, developmental, and morphological evidence to support the theory that a so-called sinus venosus defect is the consequence of persistence of foetal systemic to pulmonary veno-venous bridges, rather than of deficiencies in atrial septation.

Corresponding author
Correspondence to: Dr R. Butts, Department of Pediatrics, Medical University of South Carolina, 171 Ashley Avenue, Charleston, South Carolina 29425, United States of America. Tel: 843 792 3286; Fax: 843 792 3284; E-mail:
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1.Peacock TB. Malformations of the human heart. John Churchill, London, 1858, pp. 2425.
2.Van Praagh S, Carrera ME, Sanders SP, Mayer JE, Van Praagh R. Sinus venosus defects: unroofing of the pulmonary veins – anatomic and echocardiographic findings and surgical treatment. Am Heart J 1994; 128: 365379.
3.Anderson RH, Webb S, Brown NA. Clinical anatomy of the atrial septum with reference to its developmental components. Clin Anat 1999; 12: 362374.
4.Crystal MA, Al Najashi K, Williams WG, Redington AN, Anderson RH. Inferior sinus venosus defect: echocardiographic diagnosis and surgical approach. J Thor Cardiovasc Surg 2009; 137: 13491355.
5.Edwards JE, Helmholz HF Jr. Symposium on total anomalous pulmonary venous connection: a classification of total anomalous pulmonary venous connection based on developmental considerations. Proc Mayo Clin 1956; 31: 151160.
6.Devine WA, Anderson RH. Superior caval to pulmonary venous fistula – the progenitor of the sinus venosus defect. Pediatr Pathol 1989; 9: 345349.
7.Swan HJ, Kirklin JW, Becu LM, Wood EH. Anomalous connection of right pulmonary veins to superior vena cava with interatrial communications: hemodynamic data in 8 cases. Circulation 1957; 16: 5466.
8.Ettedgui JA, Siewers RD, Anderson RH, Park SC, Pahl E, Zuberbuhler JA. Diagnostic echocardiographic features of the sinus venosus defect. Br Heart J 1990; 64: 329331.
9.Ettedgui JA, Siewers RD, Zuberbuhler JR, Anderson RH. Echocardiographic diagnosis of inferior sinus venosus defects. Cardiol Young 1992; 2: 338341.
10.Van Praagh S, Carrera ME, Sanders S, Meyer JE Jr, Van Praagh R. Partial or total direct pulmonary venous drainage to right atrium due to malposition of septum primum: anatomic and echocardiographic findings and surgical treatment: a study based on 36 cases. Chest 1995; 107: 14881498.
11.Webb S, Brown NA, Wessels A, Anderson RH. Development of the murine pulmonary vein and its relationship to the embryonic venous sinus. Anat Rec 1998; 250: 325334.
12.Webb S, Brown NA, Anderson RH, Richardson MK. Relationship in the chick of the developing pulmonary vein to the embryonic systemic venous sinus. Anat Rec 2000; 259: 6775.
13.Webb S, Kanani M, Anderson RH, Richardson MK, Brown NA. Development of the human pulmonary vein and its incorporation in the morphologically left atrium. Cardiol Young 2001; 11: 632642.
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Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
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