Systemic venous anomalies: absent right superior vena cava with persistent left superior vena cava

Persistent left superior vena cava with an absent right superior vena cava in a 72-year-old male with multivessel coronary artery disease

“…Also, incidental access to the coronary sinus may cause hypotension, chest pain, perforation of the heart, tamponade and cardiac arrest [1,6,13,16]. Moreover, P wave abnormalities due to right atrial and ventricular enlargement, and arrhythmias due to stretching of the atrioventricular node and bundle of His may be observed on an ECG [19]. Also cardiac electrical instability affecting the sinus node may be present [2].…”

Superior Vena Cava Anomalies in the Generation of Angina Pectoris

“…Subsequently, most of the blood from the left cephalic portion of the embryo is shunted to the right causing the left anterior cardinal vein to degenerate [1,3,4,5]. Some authors believe this mechanism is due to compression of the left-sided vena cava between the left atrium and the hilum of the left lung [6].…”

“…Occasionally, this leads to stretching of the atrioventricular node and bundle of His, thereby causing arrhythmias [1, 5]. P wave abnormalities consistent with right atrial and ventricular enlargement may be noted on an EKG.…”

“…It may also be suspected when a chest X-ray reveals a widened or extra shadow around the aortic knob, with a low-density line along the upper left cardiac margin [3, 5], or when an unusually large coronary sinus is observed on echocardiography. Other tests used in detecting PLSVC include radionucleotide angiography, computerized tomography, magnetic resonance imaging, and venography [1].…”

“…This can be performed through a baffle from the vena caval opening to the right atrium or by reimplanting the PLSVC directly into the right atrium or pulmonary artery [5]. There have also been successful reports of moving the PLSVC to the right atrial appendage [9].…”