Persistent Left Superior Vena Cava: Imaging Correlation

J INVASIVE CARDIOL 2018;30(5):E39-E40.

Key words: superior vena cava, pulmonary artery catheter, right heart catheterization, complications

An 80-year-old white male was admitted with decompensated heart failure and diagnosed by transthoracic echocardiogram with severe aortic valve stenosis and moderate mitral regurgitation. His past medical history included diabetes mellitus, hypertension, atrial fibrillation, and permanent pacemaker implantation for sick sinus syndrome. He was stabilized and scheduled for right and left heart catheterization followed by TEE. Using a femoral approach, a balloon-tipped pulmonary artery (PA) catheter was placed normally into the right atrium. However, when the catheter was advanced under fluoroscopy to access the PA, it was noted that the catheter was in an abnormal position and within the same vascular structure containing the pacemaker leads (Figure 1A; Video 1). Angiogram confirmed the PA catheter was advanced through a dilated coronary sinus and placed in a persistent left SVC, which also had partial drainage into the right SVC (Figure 1B; Video 2). The PA catheter was then repositioned and right heart catheterization was completed without complications. His coronary angiogram showed absence of significant coronary artery disease. TEE confirmed the presence of the persistent left SVC with a dilated coronary sinus, severe mitral regurgitation, and aortic stenosis (Figures 1C, 1D). Computed tomography of the chest revealed an isolated persistent left SVC (Figures 1E-1G) and ruled out anomalous pulmonary vein drainage or additional congenital disease. The patient underwent minimally invasive aortic and mitral valve replacement with an uneventful recovery.

View the accompanying Video Series here.

From the ¹Columbia University Division of Cardiology at Mount Sinai Medical Center, Miami Beach, Florida; and ²Hartford Hospital, University of Connecticut, Hartford, Connecticut.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted January 20, 2018. 

Address for correspondence: Saqib Ali Gowani, MD, Hartford Hospital, University of Connecticut, 85 Seymour Street, Hartford, CT 06106. Email: saqibgowani@gmail.com