From thread to yarn, and yarn to thread: a complex case of persistent left superior vena cava
More details
Hide details
1
1st Department of Cardiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland; Centre of the European Reference Network for Rare, Low Prevalence or Complex Diseases of the Heart (ERN GUARD Heart)
Corresponding author
Julia Dołęga
Klinika Kardiologii I Katedry Kardiologii, Śląski Uniwersytet Medyczny w Katowicach, ul. Ziołowa 47, 40-635 Katowice
Ann. Acad. Med. Siles. 2025;79:24-28
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Persistent left superior vena cava (PLSVC) is a rare venous anomaly, occurring in 0.3–0.5% of the general population and up to 4.3% of patients with heart defects. It forms from the junction of the left subclavian and internal jugular veins, passes through the left mediastinum, and drains into the right atrium via the coronary sinus. Usually asymptomatic, it is typically discovered incidentally during imaging and may be associated with an atrial septal defect (ASD).
Case report:
A 52-year-old female patient with persistent atrial fibrillation, a history of ischemic stroke in the left hemisphere of the brain, uncontrolled hypertension, and diagnosed with ASD type 2, was referred for pulmonary vein isolation (PVI) due to symptomatic arrhythmia of European Heart Rhythm Association class IIb and New York Heart Association class II severity. After unsuccessful PVI, pharmacological cardioversion was attempted, followed by electrical cardioversion, which temporarily restored sinus rhythm. Echocardiography revealed moderate tricuspid valve regurgitation and an enlarged coronary sinus. Cardiac computed tomography was ordered, revealing the presence of a PLSVC, into which the left superior pulmonary vein drains, with rightward displacement of the interatrial septum and a patent foramen ovale (PFO). After cardiac surgery consultation, the patient was qualified for defect correction.
Conclusions:
PLSVC may be associated with congenital defects such as ASD type 2/PFO, which is relevant in the treatment of arrhythmias and defect correction. An enlarged coronary sinus on echocardiography should raise suspicion of PLSVC. The presence of PLSVC is significant when placing devices with central venous access.
REFERENCES (8)
1.
Uemura T., Kondo H., Shinohara T., Takahashi M., Akamine K., Ogawa N. et al. Multiple accessory pathways coexisting with a persistent left superior vena cava: a case report. J. Med. Case Rep. 2023; 17(1): 111, doi: 10.1186/s13256-023-03865-6.
2.
Polewczyk A., Kutarski A., Czekajska-Chehab E., Adamczyk P., Boczar K., Polewczyk M. et al. Complications of permanent cardiac pacing in patients with persistent left superior vena cava. Cardiol. J. 2014; 21(2): 128–137, doi: 10.5603/CJ.a2014.0006.
3.
Batouty N.M., Sobh D.M., Gadelhak B., Sobh H.M., Mahmoud W., Tawfik A.M. Left superior vena cava: cross-sectional imaging overview. Radiol. Med. 2020; 125(3): 237–246, doi: 10.1007/s11547-019-01114-9.
4.
Higgs A.G., Paris S., Potter F. Discovery of left-sided superior vena cava during central venous catheterization. Br. J. Anaesth. 1998; 81(2): 260–261, doi: 10.1093/bja/81.2.260.
5.
Sarodia B.D., Stoller J.K. Persistent left superior vena cava: case report and literature review. Respir. Care 2000; 45(4): 411–416.
6.
Sonavane S.K., Milner D.M., Singh S.P., Abdel Aal A.K., Shahir K.S., Chaturvedi A. Comprehensive imaging review of the superior vena cava. Radiographics 2015; 35(7): 1873–1892, doi: 10.1148/rg.2015150056.
7.
Demos T.C., Posniak H.V., Pierce K.L., Olson M.C., Muscato M. Venous anomalies of the thorax. AJR Am. J. Roentgenol. 2004; 182(5): 1139–1150, doi: 10.2214/ajr.182.5.1821139.
8.
Stewart J.A., Fraker T.D. Jr, Slosky D.A., Wise N.K., Kisslo J.A. Detection of persistent left superior vena cava by two-dimensional contrast echocardiography. J. Clin. Ultrasound 1979; 7(5): 357–360, doi: 10.1002/jcu.1870070506.