Intraoperative identification of persistent left superior vena cava with intracavitary electrocardiogram during venous port insertion: A report of eight cases

Abstract

Persistent left superior vena cava is a rare congenital anomaly, occurring in 0.3% to 0.5% of general population and up to 10% in patients with congenital heart disease. This anomaly is usually discovered incidentally during central venous catheterization from left side. Since 2015, we have identified eight cases of persistent left superior vena cava out of a total of 2637 patients who had left sided venous port insertion in our department. The persistent left superior vena cavae were identified with the aid of intracavitary electrocardiogram. The characteristic finding was an initial negative P-wave (in lead II), followed by a biphasic P-wave pattern during catheter insertion. All the ports worked properly, with a total catheter dwelling time of 2586 days (range: 96–756 days, mean: 323.25 days), and no catheter-related complication was observed. However, because of the paucity of clinical evidence, we should still be prudent in the long-term use of venous ports in persistent left superior vena cava.

Persistent Left Superior Vena Cava Associated with Right Aberrant Subclavian Artery Detected during Totally Implantable Vascular Access Device Insertion

“… 10 Due to local factors that prevented catheterization or port placement in the right chest, such as breast surgery, radiation therapy, and large metastatic lymph nodes at the root of the right neck, the left side will be chosen. 13 …”

“…A negative P-wave was first observed (in lead II), while a biphasic P-wave pattern appears during catheter insertion. 13 PLSVC draining into the left atrium can be identified by injecting agitated saline into the patient's left arm and observing the timing of left atrial bubbles. 12 Venography is essential to confirm PLSVC drainage into right atrium prior to catheterization when vascular variant anatomy is detected during the procedure.…”

“…Thermodilution, 3 paradoxical arterial embolism (by air embolus or thromboembolus), 13 coronary sinus thrombosis, venous stenosis, cardiac arrhythmias, cardiac tamponade, and cardiac arrest have all been reported following PLSVC catheterization. 5 Luckily, they are uncommon.…”

“…When traditional SVC catheterization is not possible, long-term PSLVC catheterization is effective, especially after determining the drainage pattern, 5 and chemotherapy can be administered safely 13 ; ensure that the tip of the catheter does not enter or pierce the coronary sinus, 4 as the presence of the guidewire, dilator, or catheter nearby can cause arrhythmias. 2 …”

“…10 Due to local factors that prevented catheterization or port placement in the right chest, such as breast surgery, radiation therapy, and large metastatic lymph nodes at the root of the right neck, the left side will be chosen. 13 A chest X-ray reveals an atypical catheter path in the left hemithorax. 2 To confirm the diagnosis, computed tomography scan, magnetic resonance imaging, or invasive angiography can be used.…”