Central venous access through a persistent left superior vena cava: a case series

A persistent left superior vena cava (PLSVC) is a rare, under-recognized congenital anomaly. The PLSVC is incidentally discovered during central venous access procedures when access is obtained from the left internal jugular vein. The vast majority of PLSVCs drain into the right atrium; however, it is critical to recognize a PLSVC that drains into the left atrium as it can predispose to systemic dispersion of emboli through bypassing the lungs. Additionally, PLSVC catheterization has also been previously reported to be associated with cardiac dysrhythmias, venous stenosis, coronary sinus thrombosis, cardiac tamponade, and cardiac arrest. This case review presents three cases which illustrate the viability and safety of a PLSVC for long-term central venous access in the setting of chemotherapy and hemodialysis. Ascertaining the drainage pattern of a PLSVC with venogram, echocardiography, computed tomography is paramount prior to long-term catheterization.