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

Abstract

A 59-year-old male presenting for a living nonrelated kidney transplant has an intraoperative left internal jugular central venous catheter placed for operative access and monitoring. Post-anesthesia care unit postoperative chest X-ray shows possible aortic placement as read by radiology. The catheter is confirmed venous on insertion, with monitoring during the operation, and with repeat transduction and venous blood gas results postoperatively. A follow-up computed tomography scan shows findings consistent with persistent left superior vena cava. This can be associated with other cardiac abnormalities and an increased risk of complications, both mechanical and physiological. Care should be taken in patients identified with persistent left superior vena cava to prevent complications in future procedures.

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].…”

“…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]. In this case, a large PLSVC, absent innominate vein, and small right SVC were found intraoperatively at the beginning of surgical transplantation.…”

“…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].…”