Congenital Anomalies of Superior Vena Cava and their Implications in Central Venous Catheterization

Abstract

Congenital anomalies of superior vena cava (SVC) are generally discovered incidentally during central venous catheter (CVC) insertion, pacemaker electrode placement, and cardiopulmonary bypass surgery. Persistent left SVC (PLSVC) is a rare (0.3%) anomaly in healthy subjects, usually asymptomatic, but when present and undiagnosed, it may be associated with difficulties and complications of CVC placement. In individuals with congenital heart anomalies, its prevalence may be up to 10 times higher than in the general population.In this perspective, awareness of the importance of the incidental finding of PLSV during CVC placement is crucial. To improve knowledge of this rare but potentially dangerous condition, we describe the embryological origin of SVC, its normal anatomy, and possible congenital anomalies of the venous system and of the heart, including the presence of a right to left cardiac shunt. Diagnosis of PLSVC as well as the clinical complications and technical impact of SVC congenital anomalies for CVC placement are emphasized.

Anomalous drainage of left superior venacava into left atrium

“…Supraventricular tachycardia, atrial fibrillation and sudden death may occur as there is a possibility to irritate the coronary sinus, where an ectopic pacemaker can be present. 8 Administering retrograde cardioplegia is difficult in the presence of an LSVC. 8 LSVC has been associated with architectural abnormalities of the sinus node and conduction tissue.…”

“…8 Administering retrograde cardioplegia is difficult in the presence of an LSVC. 8 LSVC has been associated with architectural abnormalities of the sinus node and conduction tissue. 9 We found no case reports of persistent LSVC draining the pulmonary veins into left atrium with unroofed coronary sinus morphology.…”

Catheterisation of a persistent left superior vena cava

“…Persistent left superior vena cava (PLSVC) is a rare anomaly found in about 0.3% of healthy subjects 1. This condition results from failure of the left anterior cardinal vein to degenerate during embryological development.…”

Response to: Percutaneous closure of a secundum atrial septal defect through femoral approach in an adult patient with interrupted inferior vena cava and azygos continuation

“…Generally, azygos continuation is clinically silent and is often incidentally recognized during imaging studies done for other clinical purposes. Multidetector computed tomography is the first-line noninvasive diagnostic method for characterizing the vascular anatomy and its anomalies ( 3 ). So, any possible venous variant, including azygos continuation, has to be detected in the preoperative setting of conventional thoracoabdominal surgery and percutaneous endovascular venous and cardiac procedures to plan the most suitable therapeutic approach ( 1 - 4 ).…”