Side matters: An intriguing case of persistent left superior vena-cava

Abstract

Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram (TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient's potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the right atrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.

Persistent Left Superior Vena Cava in Hematological Malignancy Requiring Central Venous Catheter Insertion for Intensive Chemotherapy

“…The patient successfully completed a total of 3 courses of salvage chemotherapy constructed with AraC, carboplatin, etoposide, and methylpredonisolone (ACES). Although obstruction of the coronary venous drainage caused by PLSVC has been suggested, it is not always thrombogenic [ 10 ]. The formation of a thrombus may depend on the PLSVC flow.…”

Persistent left-sided superior vena cava

“…1,2 It is commonly reported as an incidental finding during cardiovascular imaging, cardiothoracic surgery, and central venous catheter based procedures, which may include cardioverter-defibrillator implantation, electrophysiological procedures, and right heart catheterization. 3,4 These procedures may present with complications when a left subclavian approach is used and result in unusual catheter positions, cannulation of the coronary sinus with subsequent perforation, and technical difficulties when attempting transvenous pacing or ICD implantation.…”