Persistent Left Superior Vena Cava-When a Left-Sided Central Line Does Not Make the Turn: A Case Report

Area of Science:

• Cardiology
• Radiology
• Transplant Surgery

Background:

• Central venous catheterization is a common procedure for vascular access during major surgeries like kidney transplantation.
• Accurate placement and monitoring of central venous catheters are crucial for patient safety and effective hemodynamic management.
• Radiological confirmation of catheter position is standard practice to rule out malposition and potential complications.

Observation:

• A central venous catheter was placed via the left internal jugular vein during a kidney transplant surgery.
• Postoperative chest X-ray initially suggested possible aortic placement of the catheter.
• The catheter's venous placement was confirmed intraoperatively and through postoperative venous blood gas analysis.

Findings:

• A follow-up computed tomography (CT) scan identified findings consistent with a persistent left superior vena cava (PLSVC).
• PLSVC is a congenital anomaly where the left superior vena cava fails to regress during embryonic development.
• This anomaly can be associated with other congenital heart defects and increases the risk of catheter-related complications.

Implications:

• Identification of PLSVC is critical for guiding future invasive procedures, particularly central venous catheterization.
• Healthcare providers should exercise caution in patients with PLSVC to mitigate risks of mechanical complications (e.g., perforation, thrombosis) and physiological issues.
• Awareness and appropriate management strategies are essential to ensure patient safety in individuals with PLSVC undergoing medical interventions.