Persistent Left Superior Vena Cava (PLSVC) with a Connection to the Azygos System: Case Report and Clinical Implications

Abstract

Persistent left superior vena cava (PLSVC) is a rare anatomic variant that has a significant effect on the structure of the heart and venous system with clinical implications that are far-reaching. The presence of this variant is relevant to central venous catheter insertion, cardioverter-defibrillator placement, coronary artery bypass grafting, and numerous other medical procedures. In this report, we describe a rare case of PLSVC with a connection to the azygos system; notably, the vast majority of PLSVCs connect to the coronary sinus. We also discuss the anatomic and anesthetic considerations for individuals with this uncommon variant.

Persistent Left Superior Vena Cava—When a Left-Sided Central Line Does Not Make the Turn: A Case Report

“…3 There are associated vascular anomalies that are less benign, including an absent left brachiocephalic or innominate vein in 50% to 65% of cases, drainage into the azygos system or drainage into the left atrium causing a systemic emboli, abscesses, syncope, arrhythmias, or a right to left shunt. [3][4][5][6][7] "Isolated PLSVC" is the case where there is no right superior vena cava, and this anomaly is associated with a 50% incidence of atrial septal defect, endocardial cushion defect, tetralogy of Fallot, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, or cor triatriatum. [3][4][5][6][7][8] In our case, we had no index of suspicion that the patient had a PLSVC until the chest X-ray was taken.…”

“…[3][4][5][6][7] "Isolated PLSVC" is the case where there is no right superior vena cava, and this anomaly is associated with a 50% incidence of atrial septal defect, endocardial cushion defect, tetralogy of Fallot, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, or cor triatriatum. [3][4][5][6][7][8] In our case, we had no index of suspicion that the patient had a PLSVC until the chest X-ray was taken. We were certain that we were venous regardless of the tip projecting over the aorta given the normal if mildly dampened CVP waveform, manometry use, and ease of placement.…”

Computed tomography and magnetic resonance imaging of congenital thoracic systemic venous anomalies

“…Thoracic systemic venous anomalies may be suspected/ diagnosed by different imaging modalities [11][12][13][14][15][16][17][18][19] including echocardiography [20][21][22][23] and best detected with computed tomography (CT) angiography [24][25][26][27][28][29][30] or magnetic resonance (MR) angiography [31][32][33][34][35][36][37][38][39].…”

“…5 ). An extremely rare form of drainage of the persistent left SVC was described [ 25 ], in which the persistent left SVC drains through the accessory hemiazygos vein to the azygos vein, then to the right SVC and the right atrium, without any connection to the coronary sinus or left atrium ( Fig. 6 ).…”

Identificación de doble vena cava superior tras inserción de catéter central.

“…La persistencia de la vena cava superior izquierda (VCSI) es un hallazgo diagnosticado de forma casual mediante pruebas radiográficas. Presenta una incidencia actual de 0,3% en la población general y hasta del 10% en pacientes con cardiopatías congénitas (1). Su origen es la remanencia de la parte caudal de la vena cardinal anterior izquierda durante el periodo embrionario, de manera que se origina una vena cava superior izquierda que drena directamente en el seno coronario (2) (3).…”