Large left internal jugular vein determined during cardiac surgery: A case report

This case report presents the significant enlargement of the left internal jugular vein (IJV) detected during ultrasound (US)-guided central venous catheterization (CVC) in an adult patient undergoing cardiac surgery. An 81-year-old female patient who had severe mitral valve regurgitation, severe tricuspid valve regurgitation, and pulmonary hypertension was scheduled for Mitral Valve Replacement and DeVega Tricuspidoplasty. The patient had many comorbidities, so she was on antihypertensive (nebivolol), antithrombotic (rivaroxaban), and antidiabetic (insulin) medications. After anesthesia induction, the patient was positioned for CVC. Ultasound guidance showed that the anteroposterior diameter of the right IJV was small and the degree of overlapping of carotid artery (CA) was high. Left side was evaluated before starting the procedure. Marked enlargement of the left IJV and less overlapping of CA was observed. Left IJV catheterization was decided and performed without any complication. The surgery lasted for 3 hours and was completed uneventfully. Although right IJV is usually preferred for CVC where central intravenous access is required, it is advisable to evaluate the left IJV when the right one has a small diameter and there is a significant overlapping of right CA. In these cases, the choice for CVC side should be based on the data which is obtained from both sides.