Persistent Left Superior Vena Cava in Cardiac Congenital Surgery

Abstract

Persistent left superior vena cava (LSVC) is a relatively frequent finding in congenital cardiac malformation. The scope of the study was to analyze the timing of diagnosis of persistent LSVC, the timing of diagnosis of associated anomalies of the coronary sinus, and the global impact on morbidity and mortality of persistent LSVC in children with congenital heart disease after cardiac surgery. Retrospective analysis of a cohort of children after cardiac surgery on bypass for congenital heart disease. Three hundred seventy-one patients were included in the study, and their median age was 2.75 years (IQR 0.65-6.63). Forty-seven children had persistent LSVC (12.7 %), and persistent LSVC was identified on echocardiography before surgery in 39 patients (83 %). In three patients (6.4 %) with persistent LSVC, significant inflow obstruction of the left ventricle developed after surgery leading to low output syndrome or secondary pulmonary hypertension. In eight patients (17 %), persistent LSVC was associated with a partially or completely unroofed coronary sinus and in two cases (4 %) with coronary sinus ostial atresia. Duration of mechanical ventilation was significantly shorter in the control group (1.2 vs. 3.0 days, p = 0.04), whereas length of stay in intensive care did not differ. Mortality was also significantly lower in the control group (2.5 vs. 10.6 %, p = 0.004). The results of study show that persistent LSVC in association with congenital cardiac malformation increases the risk of mortality in children with cardiac surgery on cardiopulmonary bypass. Recognition of a persistent LSVC and its associated anomalies is mandatory to avoid complications during or after cardiac surgery.

Persistent Left Superior Vena Cava – Accidental Finding

“…PLSVC is a very important condition in cardiac surgery, being an absolute contraindication for retrograde cardioplegia (25). Furthermore, PLSVC in association with other cardiac malformations may increase postoperative mortality in children who undergo cardiac surgery, making its identification crucial in preventing intra and postoperative complications (26). Cannulation of PLSVC during surgery depends on several factors: the presence or absence of the innominate vein (between the two venae cava), the absence of the right superior vena cava, its caliber, blood flow through the left superior vena cava as well as the planned surgical procedure (27).…”

Cardiovascular imaging To uncover what is unknown or forgotten – cardiac magnetic resonance in the identification of vascular pathologies in patients after tetralogy of Fallot repair

“…However, when it drains into the left atrium it may cause significant right-to-left shunting [11]. In patients undergoing cardiac surgery, persistent left superior vena cava may cause unexpected complications during perioperative and postoperative periods [12]. Additionally, persistent left superior vena cava draining into the coronary sinus may turn out to be problematic in several other clinical scenarios such as pacemaker implantation, cannulation of central veins, and catheter ablation [11, 13–15].…”

Persistent left superior vena cava and cardiac transplantation: Anterior rerouting with anastomosis to the right atrium

“…Its prevalence is 0.4% in the general population and as high as 13% in patients with congenital heart disease. 1 It is a benign anatomic anomaly but must be addressed during certain cardiac procedures. It is especially challenging in orthotopic heart transplantation (OHT), as either a surgical redirection or preservation of the PLSVC drainage is required.…”