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Persistent left superior vena cava (PLSVC) with anomalous left hepatic vein drainage into the right atrium: role of imaging and clinical relevance

Department of Cardiovascular Medicine, University of Wisconsin Hospital and Clinics & William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

Abdul Hakeem

Department of Cardiovascular Medicine, University of Wisconsin Hospital and Clinics & William S. Middleton Memorial Veterans Hospital, Madison, WI, USA, a.hakeem{at}hosp.wisc.edu

Usman Ahmad

Yale University Medical School, New Haven, CT, USA

Maher Malik

Department of Cardiovascular Medicine, University of Wisconsin Hospital and Clinics & William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

Peter Kosolcharoen

Department of Cardiovascular Medicine, University of Wisconsin Hospital and Clinics & William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

Su Min Chang

Department of Cardiovascular Medicine, University of Wisconsin Hospital and Clinics & William S. Middleton Memorial Veterans Hospital, Madison, WI, USA

Persistent left superior vena cava (PLSVC) is a very rare and yet the most commonly described thoracic venous anomaly in medical literature. It has a 10-fold higher incidence with congenital heart disease. PLSVC often becomes apparent when an unknown PLSVC is incidentally discovered during central venous line placement, intracardiac electrode/pacemaker placement or cardiopulmonary bypass, where it may cause technical difficulties and life-threatening complications. PLSVC is also associated with disturbances of cardiac impulse formation and conduction including varying degrees of heart blocks, supraventricular arrhythmias and Wolff Parkinson White syndrome. We describe the case of an 86-year-old male with a history of coronary artery disease and chronic atrial fibrillation who presented with worsening dyspnea and syncopal episodes. An ECG was consistent with complete heart block. During lead placement for the pacemaker, a left subclavian approach was unsuccessful. A left venogram was performed through the brachial vein that demonstrated a left superior vena cava. The diagnosis was confirmed with echocardiography using a bubble study and also a chest CT. The anatomy was unique as there was anomalous left hepatic vein drainage into the right atrium. The case provides insight into the diagnostic modalities and clinical considerations of this unusual thoracic venous anomaly.

Key Words: anomalous left hepatic vein • central venous access • left superior vena cava • thoracic veins

References

• Cha EM, Khoury GH Persistent superior vena cava: radiologic and clinical significance. Radiology 1972; 103: 375—81.[Web of Science][Medline] [Order article via Infotrieve]
• Buirski G., Jordan SC, Joffe HS, Wilde P. Superior vena caval abnormalities: their occurrence rate, associated cardiac abnormalities and angiographic classification in a paediatric population with congenital heart disease. Clin Radiol 1986; 37: 131—38.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Pahwa R., Kumar A. Persistent left superior vena cava: an intensivist's experience and review of the literature. South Med J 2003; 96: 528—29.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Danielpour PJ, Aalberg JK, El-Ramey M., Sivina M., Wodnicki H. Persistent left superior vena cava: an incidental finding during central venous catheterization — a case report. Vasc Endovascular Surg 2005; 39: 109—11.
• Gonzalez-Juanatey C., Testa A., Vidan J. et al. Persistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review. Clin Cardiol 2004; 27: 515—18.[Web of Science][Medline] [Order article via Infotrieve]
• Cunha PS, Freitas A., Magno P., Gil VM Echocardiographic diagnosis of persistent left superior vena cava. Rev Port Cardiol 2006; 25: 125—27.[Medline] [Order article via Infotrieve]
• Ratliff HL, Yousufuddin M., Lieving WR et al. Persistent left superior vena cava: case reports and clinical implications. Int J Cardiol 2006; 113: 242—46[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Palinkas A., Nagy E., Forster T., Morvay Z., Nagy E., Varga A. A case of absent right and persistent left superior vena cava. Cardiovasc Ultrasound 2006; 4: 6.[CrossRef][Medline] [Order article via Infotrieve]
• Troost E., Gewillig M., Budts W. Percutaneous closure of a persistent left superior vena cava connected to the left atrium. Int J Cardiol 2006; 106: 365—66.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Ghadiali N., Teo LM, Sheah K. Bedside confirmation of a persistent left superior vena cava based on aberrantly positioned central venous catheter on chest radiograph. Br J Anaesth 2006; 96: 53—6.[Abstract/Free Full Text]
• Schummer W., Schummer C., Hoffmann E., Gerold M. Persistent left superior vena cava: clinical implications for central venous cannulation. Nutr Clin Pract 2002; 17: 304—308.[Abstract/Free Full Text]
• Peltier J., Destrieux C., Desme J., Renard C., Remond A., Velut S. The persistent left superior vena cava: anatomical study, pathogenesis and clinical considerations. Surg Radiol Anat 2006; 28: 206—10.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Tak T., Crouch E., Drake GB Persistent left superior vena cava: incidence, significance and clinical correlates. Int J Cardiol 2002; 82: 91—3.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Agnoleti G., Annecchino F., Preda L., Borghi A. Persistence of the left superior caval vein: can it potentiate obstructive lesions of the left ventricle? Cardiol Young 1999; 9: 285—90.[Web of Science][Medline] [Order article via Infotrieve]
• Masuko S., Inoue K. A case of the double superior venae cavae and an anomalous left hepatic vein opening directly into the right atrium. Kaibogaku Zasshi 1982; 57: 169—74.[Medline] [Order article via Infotrieve]
• Azuma C., Tohno Y., Tohno S., Moriwake Y., Utsumi M., Yamada M. Persistent left hepatic venous connection with the right atrium and the ductus venosus. Anat Sci Int 2002; 77: 124—27.
• Biffi M., Boriani G., Frabetti L., Bronzetti G., Branzi A. Left superior vena cava persistence in patients undergoing pacemaker or cardioverter-defibrillator implantation: a 10-year experience. Chest 2001; 120: 139—44.[Abstract/Free Full Text]
• Pai RG Echocardiographic features of persistent left superior vena cava. Echocardiography 1999; 16: 435—37.[Web of Science][Medline] [Order article via Infotrieve]
• Dearstine M., Taylor W., Kerut EK Persistent left superior vena cava: chest X-ray and echocardiographic findings. Echocardiography 2000; 17: 453—55.[Web of Science][Medline] [Order article via Infotrieve]
• Sarodia BD, Stoller JK Persistent left superior vena cava: case report and literature review. Respir Care 2000; 45: 411—26.[Medline] [Order article via Infotrieve]
• Recto MR, Elbl F., Austin E. Transcatheter closure of large persistent left superior vena cava causing cyanosis in two patients post-Fontan operation utilizing the Gianturco Grifka vascular occlusion device. Catheter Cardiovasc Interv 2001; 53: 398—404.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Higgs AG, Paris S., Potter F. Discovery of left-sided superior vena cava during central venous catheterization. Br J Anaesth 1998; 81: 260—61.[Abstract/Free Full Text]
• Okishige K., Fisher JD, Goseki Y. et al. Radiofrequency catheter ablation for AV nodal reentrant tachycardia associated with persistent left superior vena cava. Pacing Clin Electrophysiol 1997; 20(9 Pt 1): 2213—18.[CrossRef][Medline] [Order article via Infotrieve]
• Pachon M JC, Pachon M EI, Pachon M JC et al. A new treatment for atrial fibrillation based on spectral analysis to guide the catheter RF-ablation. Europace 2004; 6: 590—601. Erratum in: Europace 2005; 7: 92—3.[Free Full Text]
• Hsu LF, Jais P., Keane D. et al. Atrial fibrillation originating from persistent left superior vena cava. Circulation 2004; 109: 828—32.[Abstract/Free Full Text]
• Horlitz M., Schley P., Thiel A. et al. Wolff—Parkinson—White syndrome associated with persistent left superior vena cava. Clin Res Cardiol 2006; 95: 133—35.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Perin E., Petersen F., Rizo-Patron C., Massumi A. Coronary sinus mapping through a persistent left superior vena cava in Wolff—Parkinson—White syndrome. Tex Heart Inst J 1991; 18: 122—23.[Web of Science][Medline] [Order article via Infotrieve]
• Dibardino DJ, Fraser CD Jr, Dickerson HA, Heinle JS, McKenzie ED, Kung G. Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus. J Thorac Cardiovasc Surg 2004; 127: 959—62.[Abstract/Free Full Text]
• Pitzalis MV, Forleo C., Luzzi G. et al. Successful ablation of atrioventricular nodal reentry tachycardia in a patient with persistent left superior vena cava. Cardiologia 1998; 43: 741—43.[Medline] [Order article via Infotrieve]
• Chaudhry F., Zabalgoitia M. Persistent left superior vena cava diagnosed by contrast transesophageal echocardiography. Am Heart J 1991; 122(4 Pt 1): 1175—77.[CrossRef][Web of Science][Medline] [Order article via Infotrieve]
• Chandra A., Reul GJJr. Persistent left superior vena cava. Discovered during placement of central venous catheter. Tex Heart Inst J 1998; 25: 90.[Web of Science][Medline] [Order article via Infotrieve]

Vascular Medicine, Vol. 12, No. 4, 319-324 (2007)
DOI: 10.1177/1358863X07084859


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This Article Abstract Free Full Text (Free PDF) Free Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Bhatti, S. Articles by Su Min Chang Search for Related Content PubMed PubMed Citation Articles by Bhatti, S. Articles by Su Min Chang, Social Bookmarking                         What's this?