Indirect radiographic and angiographic signs of isolated left superior vena cava in congenital heart disease

Abstract

Blood that drains into the right atrium through an isolated left superior vena cava (LSVC) can be a complicating condition during cardiac surgery. In cases of LSVC, a double shadow can be present on standard chest X-ray over the left mediastinum. A notch along the lower contour of left atrium has been previously reported by Owen et al. in 4 cases as an indirect sign of this LSVC anomaly. These two indirect signs were evaluated in 135 (4.5%) cases of LSVC, viewing 89 chest radiographs and 40 angiograms. Their incidence, separately (17-45%) or in combination (9-20%), was observed to be frequent enough to justify a systematic search of these signs in open-heart surgery candidates.

An Alternative Technique for Cannulation of the Left Superior Caval Vein by Dislocating the Heart Into the Right Thoracic Cavity

“…The most common anomaly of SVC is persistence of LSVC, which occurs in 0.3% of general population, in 3% to 34% of patients with congenital heart diseases, and in 4.5% of patients undergoing cardiac catheterization or during cardiac surgery. 5 –7 On more than 80% of occasions, the LSVC is reported to be associated with an RSVC. If 2 SVCs are present, and are of equal size, the communicating vein may be absent or poorly developed.…”

“…The combination of absent RSVC with persistent LSVC is unusual and rare, accounting for an incidence of 0.07% to 0.13%. 7 –9…”