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Case Reports
. 2014 May 21:2014:bcr2013202999.
doi: 10.1136/bcr-2013-202999.

Persistent left superior vena cava in association with sinus venosus defect type of atrial septal defect and partial pulmonary venous return on 64-MDCT

Bansal Disha  1 , Koteshwara Prakashini  1 , Ranjan K Shetty  2
Affiliations
Case Reports

Persistent left superior vena cava in association with sinus venosus defect type of atrial septal defect and partial pulmonary venous return on 64-MDCT

Bansal Disha et al. BMJ Case Rep. .

Abstract

The most common venous abnormality of the thorax is persistent left superior vena cava (PLSVC), incidence being less than 0.5%. However, with congenital heart disease, it is about 6.1%. When the coronary sinus is dilated always search for PLSVC. The coronary sinus may communicate with the left atrium. This is known as an unroofed coronary sinus (UCS) and preoperatively documenting it is important. Of all the congenital cardiac anomalies, the sinus venosus defect (SVD) type of atrial septal defect (ASD) is most commonly associated with PLSVC and accounts for 4-11% of all ASDs. Multidetector CT can easily show all these abnormalities along with haemodynamics. On transoesophageal echocardiography it is difficult to characterise SVD and visualise a coronary sinus because of a limited window, contrast resolution and poor patient compliance. The complex of UCS and PLSVC is one such abnormality and its treatment requires careful assessment of other concomitant cardiac abnormalities to prevent post-treatment haemodynamic complications.

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Figures

Figure 1
Figure 1
Sinus venosus defect type of atrial septal defect seen as superior vena cava (star) opening into the right and left atrium forming a single chamber (triangle) with absent inter-atrial septum (RA, right atrium; LA, left atrium).
Figure 2
Figure 2
Maximum intensity projection (MIP) reformatted image showing upper lobe pulmonary veins (arrow) draining to superior vena cava (star) instead to right atrium suggestive of partial anomalous pulmonary venous connection.
Figure 3
Figure 3
(A) Axial maximum intensity projection (MIP) image showing the right and left superior vena cava (SVC; star) and its relationship with the left main bronchus. (B) Persistent left superior vena cava (PLSVC) is joining the coronary sinus (CS) which is grossly dilated in calibre and draining into right atrium. (C) PLSVC showed in coronal MIP image.
Figure 4
Figure 4
Echocardiography image showing interatrial septal defect, however presence of a small septum-like structure at the superior part made diagnoses os primum type of atrial septal defect.
See this image and copyright information in PMC

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References

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