Persistent left superior vena cava: a case report and review of literature

Abstract

Persistent left superior vena cava is rare but important congenital vascular anomaly. It results when the left superior cardinal vein caudal to the innominate vein fails to regress. It is most commonly observed in isolation but can be associated with other cardiovascular abnormalities including atrial septal defect, bicuspid aortic valve, coarctation of aorta, coronary sinus ostial atresia, and cor triatriatum. The presence of PLSVC can render access to the right side of heart challenging via the left subclavian approach, which is a common site of access utilized when placing pacemakers and Swan-Ganz catheters. Incidental notation of a dilated coronary sinus on echocardiography should raise the suspicion of PLSVC. The diagnosis should be confirmed by saline contrast echocardiography.

Figure 1

Transthoracic echocardiogram, parasternal long axis view, illustrating a dilated coronary sinus (CS). Other chambers visible are the left ventricle (LV), aorta (Ao), and left atrium (LA).

Figure 2

Chest-x-ray demonstrating unusual course of Swan-Ganz catheter (arrows) with its distal end in the proximal pulmonary artery. Note the course of the catheter into the heart on the left side of the spine, rather than the right side via the normal anatomic position of the superior vena cava.

Figure 3

Echocardiogram demonstrating the Swan-Ganz catheter (seen in cross section and indicated by the small arrow) passing via dilated coronary sinus.

Figure 4

CT thorax showing left sided superior vena Cava (large arrow).