Cardiac Arrhythmias in Patient with Isolated Persistent Left Superior Vena Cava

Area of Science:

• Cardiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Persistent left superior vena cava (PLSVC) is a rare congenital anomaly of the thoracic venous system.
• It can be associated with various cardiovascular abnormalities and may present with diverse clinical symptoms or be asymptomatic.
• Understanding its embryological basis and clinical implications is crucial for accurate diagnosis.

Observation:

• A 47-year-old male presented with atypical chest pain, fatigue, and arrhythmias.
• Clinical examination was normal; ECG revealed sinus rhythm with right bundle branch block.
• Transthoracic echocardiography showed left ventricular hypertrophy, a large coronary sinus, and mild pulmonary hypertension.

Findings:

• Saline contrast echocardiography demonstrated micro-bubbles draining into the coronary sinus and right atrium.
• Multislice computed tomography confirmed the presence of PLSVC draining into the right atrium via a large coronary sinus.
• The right superior vena cava was absent, indicating a complete interruption of the typical venous drainage pattern.

Implications:

• This case highlights the importance of a comprehensive diagnostic approach in patients with suspected or confirmed PLSVC.
• Advanced imaging modalities like CT are essential for precise anatomical delineation of venous anomalies.
• Early and accurate diagnosis of PLSVC and associated conditions can prevent potential complications and guide appropriate clinical management.