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Persistent Left Superior Vena Cava in a Heart Transplant Recipient's Native Heart: A Rare Case Diagnosed by
Faisal D Arain1, Jacqueline Sohn1, Raymond G Graber1
1University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Insights
Persistent left superior vena cava (PLSVC) is a rare anomaly. Transesophageal echocardiography aided in diagnosing PLSVC in a heart transplant recipient, emphasizing crucial surgeon communication.
Area of Science:
- Cardiology
- Anesthesiology
- Medical Imaging
Background:
- Persistent left superior vena cava (PLSVC) is a rare congenital anomaly, occurring in 0.3-0.5% of the general population.
- PLSVC is significantly more prevalent in individuals with congenital heart disease.
- While documented in surgical literature, PLSVC in heart transplant recipients remains underreported in anesthesiology.
Observation:
- A 44-year-old male orthotopic heart transplant recipient was incidentally found to have PLSVC.
- The diagnosis was made via transesophageal echocardiography following central venous catheter placement.
- Unusual central venous catheter positioning prompted suspicion and further investigation for PLSVC.
Findings:
- Transesophageal echocardiography (TEE) proved effective in diagnosing PLSVC.
- The study utilized images and videos to illustrate the diagnostic capability of TEE for PLSVC.
- This case confirms PLSVC in a heart transplant patient, a finding not previously detailed in anesthesia literature.
Implications:
- Highlights the importance of TEE in identifying vascular anomalies during cardiac procedures.
- Underscores the necessity for clear communication between anesthesiologists and surgeons regarding incidental findings like PLSVC.
- Suggests that timely communication can lead to necessary modifications in surgical plans for patient safety.
Abstract:
Persistent left superior vena cava (PLSVC) is a rare abnormality with incidence reported as 0.3% to 0.5% in the general population and about 10 times higher in patients with congenital heart disease. The diagnosis of PLSVC in native or donor hearts of patients undergoing heart transplants has been reported in surgical journals. However, this rare finding has not been described in similar heart transplant settings in anesthesia literature. This case describes a 44-year-old male orthotopic heart transplant recipient who was incidentally diagnosed with PLSVC in his native heart on transesophageal echocardiogram after a central venous catheter placement. The particular position of the central venous catheter, in our case, raised the suspicion of PLSVC but needed further verification. With the help of images and videos, we demonstrate that transesophageal echocardiogram can be instrumental in diagnosing PLSVC. Furthermore, the case highlights the importance of effectively communicating with the surgeon about such a finding so that the surgical plan can be modified in a timely manner.
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