Drainage of the Left Hepatic Vein into the Coronary Sinus, a Rare Intraoperative Finding

Abstract

In a 76-year-old female undergoing coronary artery bypass surgery, a persistent left hepatic vein was observed. Draining of this vein into the coronary sinus is an extremely rare embryological malformation and this is the first case to be reported as a solitary malformation in absence of other cardiac malformations.

Cyanosis in a patient after Fontan palliation due to unrecognised hepatic vein to coronary sinus communication

“…However, several reports suggest the importance of this finding during cardiac surgery using extracorporeal bypass, use of cardioplegia via the coronary sinus, and in cases of Fontan completion. 4,5 In our patient, the abnormal connection existed in the context of visceral heterotaxia with asplenia and anomalous pulmonary venous drainage to a common atrium, which is the first time such a connection has been described in the literature. This had a clinically important impact in this patient, resulting in significant desaturations after Fontan completion.…”

“…[1][2][3] Embryologically, it results when the left horn of the sinus venosus (which forms the coronary sinus) forms a persistent connection with the left vitelline vein system, thereby creating the left hepatic vein to coronary sinus communication. 1,4 In most cases, this anomaly is of no clinical consequence. However, several reports suggest the importance of this finding during cardiac surgery using extracorporeal bypass, use of cardioplegia via the coronary sinus, and in cases of Fontan completion.…”

Anomalous left hepatic vein to coronary sinus in a patient with atrial septal defect: Minimally invasive approach; technical challenges

“…It has no clinical or hemodynamic significance unless it is associated with other cardiac anomalies requiring surgical correction. If not detected preoperatively, this anomaly is found during IVC cannulation or looping 4 . Preoperative diagnosis helps to plan the proposed surgery properly.…”

“…If not detected preoperatively, this anomaly is found during IVC cannulation or looping. 4 Preoperative diagnosis helps to plan the proposed surgery properly.…”

Inferior sinus venosus defect and anomalous hepatic venous return to the coronary sinus leading to an Eisenmenger syndrome

“…Left hepatic vein drainage to the coronary sinus is an extremely rare and benign congenital vascular anomaly often associated with other vascular malformations such as persistent left superior vena cava, anomalous pulmonary venous drainage, interrupted inferior caval vein with azygos continuation. 4 In this case, its recognition was important to plan the heartlung transplantation. 5,6 Pulmonary arterial hypertension was likely to be related to the sinus venosus defect and the right ventricle volume overload.…”