Positional desaturation due to persistent left superior vena cava draining into the left atrium

Area of Science:

• Cardiology
• Congenital Anomalies
• Thoracic Surgery

Background:

• Persistent left superior vena cava (PLSVC) is a rare congenital anomaly affecting 0.3% of the population.
• Most commonly, PLSVC drains into the right atrium without sequelae.
• However, a subset of patients exhibit drainage into the left atrium, creating a right-to-left shunt.

Observation:

• A 60-year-old male with PLSVC draining into the left atrium presented with positional dyspnea and desaturation.
• These symptoms emerged post-trans-catheter coil embolization for coronary artery fistulas.
• The presentation suggests a link between the anomalous venous drainage and the patient's cardiopulmonary symptoms.

Findings:

• The patient's condition underscores the clinical significance of PLSVC draining into the left atrium.
• Positional desaturation can be a manifestation of this specific anatomical variation.
• This case highlights a potential complication or presentation related to interventional procedures in patients with PLSVC.

Implications:

• PLSVC draining into the left atrium should be considered in the differential diagnosis of positional desaturation.
• Accurate diagnosis and understanding of venous anatomy are crucial for managing patients with congenital heart anomalies.
• This case may inform clinical practice regarding the evaluation and management of patients with PLSVC, particularly those undergoing cardiovascular interventions.