Side matters: An intriguing case of persistent left superior vena-cava

作     者：Adeel M Siddiqui Long-Bao Cao Assad Movahed 

作者机构：Department of Cardiovascular Sciences East Carolina University Brody School of Medicine East Carolina Heart Institute GreenvilleNC 27834 United States 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2013年第1卷第5期

页      面：159-161页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Supported by The"East Carolina Heart Institute" 

主　　题：Persistent superior vena-cava Thoracic vein anomaly Central venous catheter Coronary sinus Left cardinal vein 

摘      要：Persistent left superior vena cava, usually an incidental finding, is the most common thoracic vein anatomical variation draining into the coronary sinus. Central venous catheter procedures may be complicated secondary to the presence of a persistent left superior vena cava, leading to life-threatening complications such as arrhythmias, cardiogenic shock, and cardiac arrest. We present a case of persistent superior vena cava diagnosed on transthoracic echocardiogram(TTE) in a patient with congestive heart failure. A dilated coronary sinus was identified on TTE, followed by injection of agitated saline into the left antecubital vein resulting in filling of the coronary sinus prior to the right atrium-an indication of persistent left superior vena-cava. This also was confirmed on cardiac computed tomography. Such a diagnosis is critical in patients who may undergo central venous catheter procedures such as our patient s potential requirement for an implantable cardiovertor defibrillator due to severe global left ventricular systolic dysfunction. The presence of a persistent left superior vena cava should always be suspected when the guidewire takes a left-sided downward course towards the rightatrium at the level of the coronary sinus. Therefore, special attention should be paid to the imaging work-up prior to central venous catheter procedures.