Anomalous subaortic left brachiocephalic vein in surgical cases and literature review

Abstract

Anomalous subaortic left brachiocephalic vein (ASLBV) is a rare systemic venous anomaly. We review our experience with patients associated with ASLBV who underwent cardiac surgery at three institutions. From 1989 to 2009, the medical records of surgically treated patients with ASLBV were analyzed; the incidence of ASLBV, clinical characteristics, and associated anatomical findings were assessed. Fifteen patients had ASLBV. All ASLBVs coursed left lateral to the aortic arch, passed under the ascending aorta anterior to the central pulmonary artery, and joined the right brachiocephalic vein. Fourteen patients had congenital heart disease (CHD), and the remaining patient did not have cardiac anomalies. Its incidence was 0.57% (14 of 2,449) in patients with CHD and only 0.02% (1 of 4,805) in patients without CHD. In patients with CHD, 73.3% (11 of 15) of the patients had conotruncal cardiac anomalies such as tetralogy of Fallot, ventricular septal defect with pulmonary atresia, truncus arteriosus, and interruption of the aortic arch. Eight patients had aortic arch anomalies, including right aortic arch and cervical aortic arch. The deletion of chromosomal 22q11.2 was confirmed in two patients, and one patient was diagnosed with DiGeorge syndrome. ASLBV was clinically silent even without any surgical intervention. ASLBV is a very rare anomaly and is highly associated with conotruncal cardiac anomalies and aortic arch anomalies, including right aortic arch and cervical aortic arch. Preoperative diagnosis is important when any surgical interventions are intended, especially, in patients with conotruncal cardiac anomalies.

Anomalous left brachiocephalic vein: important vascular anomaly concomitant with congenital anomalies and heart diseases

“…Right sided aortic arch is another abnormality seen with high frequency in ALBCV patients. This aortic abnormality has been reported in ALBCV patients as high as 46% [14], 70% [19], 77% [3] and 86% [10]. In a study by Choi et al [4] it was shown that the presence of ALBCV in other congenital heart anomalies such as TOF, VSD or pulmonary atresia is associated with higher incidence of right sided aortic arch.…”

“…High incidence of other cardiac abnormalities in these patients has been reported previously [4,6,10]. In a study published at 2010, Nagashima et al [14] reviewed surgical records of 4805 patients and found 15 patients with ALBCV. CHD was seen in 14 and there was just 1 patient without other congenital heart anomalies.…”

“…Anomalous retro-aortic left brachiocephalic vein is an anomaly seen in about 0.5-1.7% of all children with CHD [3,4,6,10,14]. Herein, we reported the prevalence of cardiovascular anomalies in 22 young patients with ALBCV.…”

“…Presence of TOF in the ALBCV patients is a common finding and varies between 40% and 42% [4,14], 77% [3], 87.5% [10] and 93% [6] among studies. Although the frequency of TOF in these patients is extremely high, ALBCV is not a common finding in TOF patients and has been seen in 5% to 8.5% of them [4,6,10].…”

A rare vascular anomaly in the form of double left brachiocephalic vein detected incidentally during cardiac implantable electronic device (CIED) placement

“…At the eighth week of gestation, the paired anterior cardinal veins anastomose to form the brachiocephalic vein (BCV). Any disruption of this stage of embryonic development may result in BCV anomalies, including a double left BCV, presented in this paper [3,10,11,14,17].…”