Persistent Left Superior Vena Cava Beyond Anatomy

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly, occurring in 0.3% to 0.5% of the general population and in 10% of patients with congenital heart disease. Historically considered benign, PLSVC is increasingly recognized for its clinical significance in the fields of interventional cardiology, electrophysiology, and surgery. The present narrative review combines the available evidence regarding PLSVC, focusing on its embryology, anatomical variants, diagnostic challenges, and tailored management strategies, to address clinical uncertainties and improve procedural outcomes for patients undergoing intervention. The clinician needs to understand the risk for right-to-left shunting of PLSVC, procedural risk during placement of the catheter or device, and its association with arrhythmias and stroke. Common in high-risk patients (eg, in congenital heart disorders, unexplained hypoxia), early detection by advanced imaging and forward procedural planning are key to reducing complications and optimizing patient outcomes.