Orthotopic heart transplantation with reconstruction of persistent left superior vena cava

Abstract

Background: Persistent left superior vena cava is a not uncommon congenital vascular abnormality. We report a case of heart transplantation with reconstruction of persistent left superior vena cava using a prosthetic vascular graft. Case presentation: A 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient's postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications. Conclusions: Reconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.

Perioperative Management of a Donation After Circulatory Death Heart Transplant in a Recipient With a Persistent Left Superior Vena Cava

“…While PLSVC is a common congenital venous abnormality, it only occurs in about 0.5% of the normal population [1][2][3][4][5][6]. Some evidence can suggest the presence of a PLSVC prior to surgery, such as mediastinal widening or an abnormally positioned CVC on chest X-ray; however, there was no indication of a PLSVC seen in this patient's preoperative workup [5,[8][9].…”

“…Persistent left superior vena cava (PLSVC) is a common congenital venous abnormality, with an overall prevalence of 0.3% to 0.5% [1][2][3][4][5][6]. Prevalence in patients with congenital heart disease is 2.8% to 4.3% [1][2][3][4][5].…”

“…Persistent left superior vena cava (PLSVC) is a common congenital venous abnormality, with an overall prevalence of 0.3% to 0.5% [1][2][3][4][5][6]. Prevalence in patients with congenital heart disease is 2.8% to 4.3% [1][2][3][4][5]. Specific evidence can suggest the presence of a PLSVC prior to surgery, such as an abnormally positioned central venous catheter, mediastinal widening, or retrocardial echographic free space indicating a dilated coronary sinus [3][4].…”

Commentary: Cardinal principles

“…For those without a bridging vein, incorporation of the systemic venous drainage from the left upper body will be required, for which any number of clever techniques have been proposed depending on the continuity of the LSVC with an intact coronary sinus (in contrast to entrance into the dome of the left-sided atrium or previous usage for a cavopulmonary anastomosis). 1 , 2 , 3 , 4 …”

“…For those without a bridging vein, incorporation of the systemic venous drainage from the left upper body will be required, for which any number of clever techniques have been proposed depending on the continuity of the LSVC with an intact coronary sinus (in contrast to entrance into the dome of the left-sided atrium or previous usage for a cavopulmonary anastomosis). [1][2][3][4] In this issue of JTCVS Techniques, de Magalhães Ferraz and colleagues 5 have presented a rare instance in which an innominate vein persisted but all the upper body (right and left) systemic veins were draining through a persistent LSVC to the coronary sinus (without situs inversus totalis-the inferior cava was right sided) and have proposed a clever solution to "bridge the gap" to the normal situs donor heart. 5 Their results, as illustrated in the intraoperative and 3-dimensional reconstructions, are enviably unobstructed, albeit quite similar to the techniques reported previously.…”