Persistent Left Superior Vena Cava: A Case Report and Review of Literature
Persistent Left Superior Vena Cava: A Case Report and Review of Literature
Persistent left superior vena cava is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in isolation but can be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. The presence of PLSVC can render access to the right side of heart challenging via the left subclavian approach, which is a common site of access utilized when placing pacemakers and Swan-Ganz catheters. Incidental notation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography.
Persistent left superior vena cava (PLSVC) is an uncommon vascular anomaly; however, it is the most common congenital anomaly of thoracic venous system. It is usually asymptomatic and is detected when cardiovascular imaging is performed for unrelated reasons. When a left subclavian approach is used for vascular access, its presence can complicate catheter placement within the right side of heart. Here we present a case that highlights the practical implications PLSVC. Further, we review a diagnostic approach and provide insight into the embryonic basis of this anomaly.
Abstract and Background
Abstract
Persistent left superior vena cava is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in isolation but can be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. The presence of PLSVC can render access to the right side of heart challenging via the left subclavian approach, which is a common site of access utilized when placing pacemakers and Swan-Ganz catheters. Incidental notation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography.
Background
Persistent left superior vena cava (PLSVC) is an uncommon vascular anomaly; however, it is the most common congenital anomaly of thoracic venous system. It is usually asymptomatic and is detected when cardiovascular imaging is performed for unrelated reasons. When a left subclavian approach is used for vascular access, its presence can complicate catheter placement within the right side of heart. Here we present a case that highlights the practical implications PLSVC. Further, we review a diagnostic approach and provide insight into the embryonic basis of this anomaly.