Isolated persistent left superior vena cava: A case report and its clinical implications

Abstract

The venous anomaly of a persistent left superior vena cava (PLSVC) affects 0.3%–0.5% of the general population. PLSVC with absent right superior vena cava, also termed as “isolated PLSVC,” is an extremely rare venous anomaly. Almost half of the patients with isolated PLSVC have cardiac anomalies in the form of atrial septal defect, endocardial cushion defects, or tetralogy of Fallot. Isolated PLSVC is usually innocuous. Its discovery, however, has important clinical implications. It can pose clinical difficulties with central venous access, cardiothoracic surgeries, and pacemaker implantation. When it drains to the left atrium, it may create a right to left shunt. In this case report, we present the incidental finding of isolated PLSVC in a patient who underwent aortic valve replacement. Awareness about this condition and its variations is important to avoid complications.

Gradual diagnosis and clinical importance of prenatally detected persistent left superior vena cava with absent right superior vena cava – a case report and literature review

“…The ratio of the incidence of PLSVC in CHD patients to that in the normal population was very high (over hundredfold) in CoA and DORV group ( 6 ) . There is a high prevalence of ventricular septal defect, atrial septal defect, endocardial cushion defect, cortriatriatum and tetralogy of Fallot in patients with PLSVC and agenesis of the right SVC ( 15 ) . Additionally, in patients with pulmonary valve stenosis, where the incidence of PLSVC was the lowest, it was 7.0 times higher than that of the normal population ( 8 ) .…”

“…In electrocardiographic record, left axis deviation of the P wave with shortened PR interval may be present. X-ray might show additional shadow of the PLSVC ( 15 , 17 , 18 ) .…”

Inability to Utilize Retrograde Cardioplegia due to a Persistent Left Superior Vena Cava

“…Cases have been described where central venous catheters placed through the left internal jugular vein for vasopressor support were unintentionally placed into the tract continuous with the coronary sinus [ 5 , 6 ]. Particularly when the left subclavian vein is used for access, as a result of the abnormal proximity to the coronary sinus, there is additional concern for the catheter and associated guidewire causing arrhythmias, hemodynamic stability, and perforation of the heart [ 7 , 8 ]. Some authors have used catheters that were placed in the coronary sinus for drug and volume administration, although close proximity of the tip of the catheter to the coronary sinus could have the same risks as the guidewire [ 9 ].…”

“…Some authors have used catheters that were placed in the coronary sinus for drug and volume administration, although close proximity of the tip of the catheter to the coronary sinus could have the same risks as the guidewire [ 9 ]. In addition, pulmonary artery catheter and pacemaker lead placement can be difficult due to a tortuous anatomy [ 7 , 10 ].…”

“…Failure to diagnose a PLSVC and use of retrograde cardioplegia alone can result in inadequate myocardial protection and cardiogenic shock. Diagnosis should also be followed by an evaluation for other congenital abnormalities such as atrial and/or ventricular septal defects, cor triatriatum, coarctation of the aorta, and endocardial cushion defects [ 7 , 13 , 14 ]. Regardless of the presence of any associated abnormalities, it is imperative to promptly communicate the presence of a PLSVC to the surgical and perfusion team.…”