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Persistent left superior vena cava identified by transesophageal echocardiography
Sofia A Horvath1, Nicholas Suraci2, Jayanand D'Mello2
1Echocardiography Laboratory, Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA.
Reviews in Cardiovascular Medicine
|July 27, 2019
Summary
A persistent left superior vena cava was identified during routine catheter placement in a patient undergoing aortic valve replacement. Awareness of this common thoracic venous anomaly is crucial for preventing procedural complications.
Area of Science:
- Cardiology
- Vascular Anatomy
- Medical Imaging
Background:
- Severe aortic stenosis necessitates aortic valve replacement.
- Routine preoperative Swan-Ganz catheterization is standard for hemodynamic monitoring.
- Thoracic venous anomalies, though rare, can complicate central venous access.
Observation:
- Transesophageal echocardiography revealed a dilated coronary sinus with an indwelling catheter.
- An agitated saline study confirmed flow from the coronary sinus into the right atrium.
- This pattern indicated a persistent left superior vena cava (PLSVC).
Findings:
- The patient presented with severe aortic stenosis and underwent aortic valve replacement.
- A persistent left superior vena cava was incidentally discovered during preoperative Swan-Ganz catheter placement.
- The PLSVC did not cause immediate complications in this case.
Implications:
- Persistent left superior vena cava is the most common thoracic venous anomaly.
- Undiagnosed venous anomalies increase risks during central venous cannulation.
- Clinician awareness of PLSVC can prevent iatrogenic complications and guide safe catheterization.
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