Left superior vena cava: revisited

Abstract

The persistence of a left-sided superior vena cava is the most common variant of systemic venous drainage. Increased utility of cardiac imaging, in particular cross-sectional techniques such as computed tomography and magnetic resonance (MR), will result in increased detection of the anomaly and its variants. Whilst in the typical form it is often haemodynamically insignificant, its discovery may have clinical significance nonetheless, and its mimics require exclusion. During cardiac development the anomaly results from a failure of the left anterior cardinal vein to obliterate. Recognized anatomical variants include the absence of the right superior vena cava and of an innominate bridging vein. Typical drainage is to the coronary sinus, dilatation of which may be the first hint to the anomaly. Clinical implications with respect to vascular access and arrhythmia are well described. A significant minority drain into the left atrium, potentially creating a haemodynamically significant lesion. Additionally, differentiation from anomalous left upper pulmonary venous drainage via a vertical vein is mandatory. A newly discovered variant runs an intra-atrial course with subsequent typical drainage, and if not recognized as such, may be confused with a left atrial mass. The use of 3D contrast-enhanced MR venography has proven extremely helpful in characterizing anomalous vasculature, and we demonstrate how such techniques can help delineate the anomaly and differentiate from its mimics.

Ligament and vein of Marshall: A therapeutic opportunity in atrial fibrillation

“…The left anterior cardinal vein connects caudally with the duct of Cuvier-later the coronary sinus (CS)- and with the subclavian/innominate vein in the cephalad direction (Figure 1A). 5 It may remain open as the normal variant of persistent left superior vena cava, but most commonly only its intracardiac portion remains patent as the VOM (also known as oblique vein of the left atrium (LA)), connected with the CS at the level of the valve of Vieussens. In the adult, the LOM contains portions of the VOM, a myocardial sleeve (the Marshall bundle [MB]), and autonomic nerves 6 .…”

“…5 Even if the ligament is patent as the VOM, whether the VOM provides any venous drainage function to the LA was unclear. We showed that the VOM serves a true venous function that communicated with the underlying myocardium and is therefore a viable vascular route for the delivery of therapeutic agents to the LA myocardium.…”

Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT)

“…[137][138][139][140][141][142] Systemic venous anomalies are also well visualized by cardiovascular CT. [143][144][145] Cardiovascular CT has also been shown to accurately visualize congenital aortic anomalies including interrupted aortic arch and aortic coarctation in both pediatric and adult patients. [146][147][148][149][150][151][152][153] It is particularly useful for evaluation of the aortic arch after endovascular intervention (stent or stent graft) where aneurysm, aortic wall injury or recurrent arch obstruction are relatively common.…”

A Persistent Left-Sided Superior Vena Cava With Agenesis of the Right Superior Vena Cava in a Patient Who Underwent Liver Transplantation: A Case Report

“…Persistent left-sided superior vena cava (PLS-SVC) is the most common venous mediastinal variant with a prevalence estimated approximately of 0.3-0.5% in the general population [1,2] and of 4% in patients with congenital heart diseases [3]. In 90% of cases, the superior vena cava (SVC) is bilateral.…”