Isolated retroaortic left innominate vein in an adult without cardiac or aortic anomalies

Abstract

Retroaortic innominate vein is an uncommon variant reported in patients with congenital heart disease. However, isolated retroaortic innominate vein without associated cardiac or arch anomalies is extremely rare. We present a case of a 68-year-old man who was found to have this anomalous variant incidentally on computed tomography (CT) of the thorax. We also briefly discuss its associations, embryology, and clinical significance.

Anomalous left brachiocephalic vein: important vascular anomaly concomitant with congenital anomalies and heart diseases

“…Isolated ALBCV without concomitant cardiac or arch anomalies is tremendously rare [14][15][16][17]. This anomaly arises from an abnormal embryological development of precardinal veins at 8 th week of foetal development.…”

“…Most of the left anterior cardinal veins should disappear and new transverse anastomotic channels by capillary plexus should be made in order to drain the left side of head and neck and left arm. If the aortic arch does not shorten during embryological development, it will prevent the development of transverse venous plexus and leads to formation of an anomalous course of innominate vein [6,12,16,17,19].…”

“…The isolated form of ALBCV is usually seen in adults. Srinivasan et al [17] presented a 68-yearold man who was incidentally diagnosed to have this anomaly on thorax CT without other cardiac or aortic anomalies. Park et al [16] reported a 63-year-old man of isolated ALBCV that was incidentally detected by performing transoesophageal echocardiography and CT.…”

“…In isolated form, this abnormality can cause technical problems during interventions through left arm or neck surgery. Also in cardiac surgery, ALBCV needs different surgical strategies; in cardiopulmonary bypass, the SVC should be cannulated more caudally than usual in order to avoid obstruction of retro-aortic brachiocephalic vein or sometimes they need ductal ligation, subclavian to pulmonary artery shunting or operative management of staged single ventricle palliation [2,10,17].…”

“…Unawareness of such anomalies before sternotomy or heart transplantation, could lead to vascular injury, disastrous surgical results and increase the morbidity and mortality [2,7,17]. Particularly in patients with right ventricular outflow tract obstruction, it should be considered in order to decide the plan during surgery [10].…”