Inability to Utilize Retrograde Cardioplegia due to a Persistent Left Superior Vena Cava

Abstract

A persistent left superior vena cava is a congenital abnormality that affects a minority of the general population. While this finding is not hemodynamically significant in all patients, failure to recognize the altered anatomy in any of these patients can be consequential during procedures such as central venous catheter placement, pacemaker/defibrillator wire placement, and use of retrograde cardioplegia during cardiac surgery. We present a case of an intraoperative diagnosis of a persistent left superior vena cava that altered the original plan to arrest the heart using retrograde cardioplegia. Echocardiography was instrumental in this diagnosis and avoided potentially inadequate myocardial protection during cardiopulmonary bypass.

Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava and Discrete Subaortic Stenosis Diagnosed in a Patient with Sick Sinus Syndrome: A Case Report and Brief Review of the Literature

“…Other pacing modalities such as leadless pacemaker or epicardial pacing systems might be an option whenever conventional therapy cannot be implemented [ 33 , 37 ]. Cardiovascular surgery in patients with a PLSVC requires special consideration because specific heart cannulation techniques are needed and retrograde cardioplegia may lead to insufficient myocardial protection [ 38 , 39 ]. In addition, the ligation of an isolated PLSVC may cause SVC syndrome and myocardial ischemia if coronary sinus atresia is associated [ 5 , 40 ].…”