Persistent left superior vena cava in association with sinus venosus defect type of atrial septal defect and partial...

Area of Science:

• Cardiovascular Imaging
• Thoracic Venous Anatomy
• Congenital Heart Disease

Background:

• Persistent left superior vena cava (PLSVC) is the most frequent thoracic venous anomaly, with a higher incidence in congenital heart disease.
• Dilatation of the coronary sinus is a key indicator for investigating PLSVC.
• Unroofed coronary sinus (UCS) is a potential communication between the coronary sinus and the left atrium, requiring preoperative documentation.

Observation:

• Sinus venosus defect (SVD) atrial septal defects (ASDs) are frequently associated with PLSVC, accounting for 4-11% of all ASDs.
• Multidetector CT effectively visualizes PLSVC, UCS, SVD, and associated hemodynamic changes.
• Transesophageal echocardiography has limitations in characterizing SVD and visualizing the coronary sinus due to window constraints and image quality.

Findings:

• The co-occurrence of UCS and PLSVC presents a complex anatomical challenge.
• Accurate preoperative assessment of these anomalies is crucial for effective management.
• Associated cardiac abnormalities must be carefully evaluated to prevent post-treatment hemodynamic complications.

Implications:

• Early and accurate diagnosis of PLSVC, UCS, and SVD is vital for surgical planning.
• Multidetector CT offers superior visualization compared to transesophageal echocardiography for these anomalies.
• Comprehensive assessment prevents potential hemodynamic complications following interventions for complex venous and cardiac abnormalities.