An elusive persistent left superior vena cava draining into left atrium

Area of Science:

• Cardiology
• Medical Imaging
• Congenital Heart Disease

Background:

• Persistent left superior vena cava (PLSVC) is a rare congenital anomaly where the left superior vena cava fails to regress during embryonic development.
• It typically drains into the coronary sinus, but drainage into the left atrium is an uncommon variation.
• Diagnosis can be challenging, especially when associated with other cardiac abnormalities.

Observation:

• A case report detailing a patient with a PLSVC draining directly into the left atrium.
• The patient also presented with fibromuscular left ventricular outflow tract obstruction and a small atrial septal defect.
• The anomalous vessel was not identified during previous right and left heart catheterizations via the right arm and open-heart surgery.

Findings:

• The PLSVC was incidentally discovered during a cardiac catheterization performed via the left arm.
• Contrast echocardiography confirmed the anomalous venous drainage and associated cardiac defects.
• This highlights the importance of the catheterization approach in diagnosing complex congenital heart anomalies.

Implications:

• This case underscores the potential for missed diagnoses of PLSVC, even with invasive cardiac procedures.
• It emphasizes the diagnostic utility of left-sided cardiac catheterization for identifying anomalous venous connections.
• Accurate anatomical delineation is crucial for appropriate management and surgical planning in patients with congenital heart disease.