Left superior vena cava: a vascular abnormality discovered following pulmonary artery catheterization

Abstract

Persistence of the left superior vena cava (LSVC) is an uncommon congenital disorder, which is normally asymptomatic. Nevertheless, it can create difficulty during central venous and pulmonary artery catheterization.We present a patient with LSVC that was discovered upon radiological confirmation of the correct placement of a pulmonary artery catheter. Case reportThe patient was a 67-yr-old woman with a history of arterial hypertension and posteroinferior myocardial infarction, who was being treated with nitrites, betablockers and angiotensin converting enzyme inhibitors. On arrival in the emergency room, she presented with arrhythmias and dyspnoea with vegetative signs. Presyncope and a rhythm disorder, attributed to an overdose of beta-blockers, were initially suspected. During her hospital stay, ECG confirmed the diagnosis of angina with anteroseptal ischaemia. Catheterization disclosed the presence of a lesion involving the cicumflex artery, anterior descending artery and the middle third of the right coronary artery. She was scheduled to undergo myocardial revascularization with extracorporeal circulation (ECC).In the operating room, central venous pressure was easily monitored via the right internal jugular vein. During surgery, the right atrium and aorta were cannulated and cardioplegia was administered through the CAN J ANAESTH 1996 / 43:6 / pp626-8

Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients

“…Those papers in the literature that have specifically addressed the incidental finding of PLSVC at the time of placement of some sort of central venous access device or some sort of central venous monitoring device [38,42,44-123] have generally been directed towards physicians practicing anesthesia [47,48,52,55,58-60,62,64,65,68-71,73,78,85,88,91,92,94,102,117,120,123], critical care [45,46,49-51,53,56,57,72,77,79,83,106,109,110,114,116,119,122], and nephrology [54,66,74,76,80,87,95,96,100,103,104,107,108,113,118]. Despite the fact that a plethora of papers have been published on various aspects of PLSVC and despite there being multiple case reports describing the incidental finding of PLSVC at the time of central venous device placement, there has been very little in the literature specifically directed toward the potential importance of the incidental finding of PLSVC to surgeons, interventional radiologists, and other physicians who are actively involved in central venous access device placement in cancer patients [61,81,82,84,111].…”

Agenesia de cava superior associada a bloqueio atrioventricular de 3º grau

“…The significance of the persistence of the left superior vena cava is based on it high prevalence when associated to cardiovascular congenital defects and arrhythmia. Persistence of the Left superior vena cava was found in 20% of the cases of patients with tetralogy of Fallot and in 8% of the patients with Eisenmenger syndrome [1].…”

“…The estimated prevalence is nearly 0.3% in healthy individuals and 4.5% in individuals with congenital heart diseases [1]. The right superior vena cava is present in most patients.…”

“…It is typically asymptomatic and often detected during or after the placement of pacemaker catheter via subclavian or jugular venous routes [1]. However, it can be detected incidentally during a chest computed tomography (CT) screening or even through a necropsy finding [2].…”

Persistierende linke Vena cava superior

“…Die Diagnose ist zu stellen mittels Phlebographie, transthorakaler und transösopha-gealer Echokardiographie, Angiographie, Computertomographie sowie Kernspintomographie [5]. Der abnorme Gefäßverlauf kann zu verschiedenen klinisch bedeutsamen Komplikationen führen, wie schwierige Platzierung von zentralen Venen-oder Pulmonaliskathetern [2,4,6], Auftreten von paradoxen Embolien bei gleichzeitig vorhandenem Vorhofseptumdefekt [6] oder kardialen Arrhythmien inklusive Kammerflimmern [4].…”