The Left-Sided Superior Vena Cava

Campbell, Maurice; Deuchar, D C

doi:10.1136/hrt.16.4.423

Cited by 247 publications

(93 citation statements)

References 19 publications

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“…2,10 Since the initial descriptions of this anomaly by Edwards and DuShane in 1950, 12 no more than 207 cases have been described; its prevalence was 0.3% in healthy individuals and 4.4% in patients with congenital heart disease. 11,13,14 In our series, 0.001% of patients who underwent TTE showed a PLSVC.…”

Section: Discussionmentioning

confidence: 98%

Persistent left superior vena cava draining into the coronary sinus: Report of 10 cases and literature review

González‐Juanatey

Testa

Vidan

et al. 2004

Clinical Cardiology

114

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Background: Persistent left superior vena cava (PLS VC) is the most common thoracic venous anomaly.Hypothesis: This study examines the epidemiologic, clinical, and morphologic characteristics of a cohort of patients with PLSVC draining into the coronary sinus.Methods: We examined the clinical and morphologic characteristics of patients with PLSVC draining into the coronary sinus diagnosed at a single referral hospital for a defined population in northwestern Spain. We designed a prospective study of the case records of all patients diagnosed with PLSVC draining into the coronary sinus at the echocardiog‐raphy laboratory of the Hospital Xeral‐Calde from January 2001 through December 2002. Patients were included if they had a PLSVC diagnosed by transthoracic echocardiogram (TTE) using an echo‐contrast enhancement and confirmed by a magnetic resonance (MR) imaging. Ten patients (6 women) fulfilled the inclusion criteria described above. All patients were adults and had associated heart disease, including a congenital heart disease in three cases.Results: Magnetic resonance imaging examination confirmed the presence of PLSVC and the site of drainage into the coronary sinus. Absence of the right superior vena cava was observed only in three patients, in whom the main coronary sinus size was significantly increased. Absence of the left bra‐chiocephalic vein was diagnosed in five patients.Conclusion: This study describes 10 new cases of PLSVC and supports the necessity of considering PLSVC draining into the coronary sinus in the diagnosis of patients presenting with dilated coronary sinus diagnosed by TTE. It also underlines the important role of MR imaging in the evaluation of these abnormalities. An associated heart disease must always be excluded in these patients.

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Section: Discussionmentioning

confidence: 98%

Persistent left superior vena cava draining into the coronary sinus: Report of 10 cases and literature review

González‐Juanatey

Testa

Vidan

et al. 2004

Clinical Cardiology

114

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“…In each, the catheter followed a usual course in the thoracic cavity to the level of the left superior mediastinum. 6 the values were 85 and 87 per cent, respectively. In the third case the level of oxygen saturation in the right atrium was 89 per cent; in the left atrium, 93 per cent.…”

Section: Absent Coronary Sinusmentioning

confidence: 91%

Termination of Left Superior Vena Cava in Left Atrium, Atrial Septal Defect, and Absence of Coronary Sinus

et al. 1965

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Eight cases of termination of the left superior vena cava in the left atrium are reviewed pathologically and clinically. In three of the five patients who died, pathologic examination revealed three anomalies which, together, are considered to form a developmental complex. The anomalies are (1) termination of the left superior vena cava in the left atrium, (2) absence of the coronary sinus, and (3) an atrial septal defect lying in the postero-inferior angle of the atrial septum. In the two remaining fatal cases, the aforementioned anomalies were associated with persistent common atrioventricular canal. In this situation, the atrial septal defect of the latter malformation was confluent with the atrial septal defect of the anomalous complex described. The coexistence of three anomalies-the left superior vena cava terminating in the left atrium, absent coronary sinus, and atrial septal defect-is considered to result from a single developmental abnormality. This takes the form of failure of complete formation of the left atriovenous fold, that fold which normally develops along the left side of the junction of the sinus venosus and the atrial portion of the heart. Clinically, features of increased pulmonary blood flow, coupled with duskiness of the skin, were the significant abnormalities. When cardiac catheterization was attempted through a right-sided vein, the data revealed a left-to-right shunt at atrial level, while levels of arterial oxygen desaturation were present. Except in cases with coexistent ventricular septal defect, pulmonary hypertension was absent. In each of the four patients in whom cardiac catheterization was performed through a left antecubital vein, the catheter was advanced into the left superior vena cava, left atrium, and left ventricle. This was substantiated by angiocardiography in three of the four patients. In our experience, angiocardiography was the most reliable procedure to substantiate the termination of the left superior vena cava in the left atrium. The present study suggests that, in the absence of pulmonary hypertension, a left-to-right transatrial shunt associated with systemic arterial oxygen desaturation may indicate the presence of a persistent left superior vena cava terminating in the left atrium. Moreover, an atrial septal defect identified surgically as lying in the postero-inferior angle of the atrial septum should suggest that an additional anomaly may be present in the form of termination of the left superior vena cava in the left atrium.

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“…PLSVC occurs in Ϸ0.3% of the general population and in 4% to 10% of patients with congenital heart disease. 1 It is the most common form of anomalous system venous return. In Ϸ90% of the cases, PLSVC drains into the right atrium via the coronary sinus and does not lead to any shunt.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Abscess Due to Persistent Left Superior Vena Cava Draining Into the Left Atrium

Lee

Pande²,

Rao³

et al. 2011

Circulation

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A 47-year-old woman with a history of paroxysmal atrial fibrillation presented with seizure. She noted progressive fatigue in the preceding 6 months. The week before admission, she had worsening headaches and increased irritability. On the day of admission, she developed an episode of grand-mal seizure. MRI of the brain revealed a round lesion in the left frontal lobe measuring 11 cm by 15 mm with an extensive halo of T2 hyperintensity surrounding the lesion and minimal inherent T1 high signal along the border. The lesion was suspicious for an abscess. She was taken to the operating room for biopsy. Craniotomy and corticectomy revealed an abscess cavity with a large amount of purulent material. Culture of the purulent drainage grew Streptococcus intermedius. She was started on penicillin G and metronidazole.A transthoracic echocardiogram revealed normal right and left ventricular size and function (Movie I in the online-only Data Supplement). There was mild left atrial enlargement without evidence for significant valvular abnormalities. Doppler interrogation of the septum in the subcostal view revealed abnormal color flow in the inferoposterior part of the interatrial septum suspicious for a left-to-right shunt ( Figure 1 and Movie II in the online-only Data Supplement). Chest x-ray to confirm placement of a peripherally inserted central catheter line showed the tip of the line overlying a left-sided superior vena cava (Figure 2).To further characterize her anatomy, a cardiac MRI was obtained. MRI with gadolinium contrast revealed a persistent left superior vena cava (PLSVC) opening into the left atrium (Figure 3). MRI also showed complete unroofing of the coronary sinus (Figure 4), which directly communicated with the left atrium and formed a left-to-right shunt. The coronary sinus was enlarged and measured 13 mm at its opening to the right atrium. The Qp/Qs shunt ratio was 1.8 to 1, indicating significant left-to-right shunting ( Figure 5A and 5B).The patient's left-sided peripherally inserted central catheter line was removed, and a new right-sided peripherally inserted central catheter line was placed for long-term antibiotic administration. After discharge, anaerobic cultures grew Capnocytophaga and treatment was changed to ertapenem. She completed an 8-week course of antibiotics. Repeat MRI of the brain

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The Left-Sided Superior Vena Cava

Cited by 247 publications

References 19 publications

Persistent left superior vena cava draining into the coronary sinus: Report of 10 cases and literature review

Persistent left superior vena cava draining into the coronary sinus: Report of 10 cases and literature review

Termination of Left Superior Vena Cava in Left Atrium, Atrial Septal Defect, and Absence of Coronary Sinus

Cerebral Abscess Due to Persistent Left Superior Vena Cava Draining Into the Left Atrium

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