From thread to yarn, and yarn to thread: a complex case of persistent left superior vena cava

Abstract

Introduction: Persistent left superior vena cava (PLSVC) is a rare venous anomaly, occurring in 0.3–0.5% of the general population and up to 4.3% of patients with heart defects. It forms from the junction of the left subclavian and internal jugular veins, passes through the left mediastinum, and drains into the right atrium via the coronary sinus. Usually asymptomatic, it is typically discovered incidentally during imaging and may be associated with an atrial septal defect (ASD). Case report: A 52-year-old female patient with persistent atrial fibrillation, a history of ischemic stroke in the left hemisphere of the brain, uncontrolled hypertension, and diagnosed with ASD type 2, was referred for pulmonary vein isolation (PVI) due to symptomatic arrhythmia of European Heart Rhythm Association class IIb and New York Heart Association class II severity. After unsuccessful PVI, pharmacological cardioversion was attempted, followed by electrical cardioversion, which temporarily restored sinus rhythm. Echocardiography revealed moderate tricuspid valve regurgitation and an enlarged coronary sinus. Cardiac computed tomography was ordered, revealing the presence of a PLSVC, into which the left superior pulmonary vein drains, with rightward displacement of the interatrial septum and a patent foramen ovale (PFO). After cardiac surgery consultation, the patient was qualified for defect correction. Conclusions: PLSVC may be associated with congenital defects such as ASD type 2/PFO, which is relevant in the treatment of arrhythmias and defect correction. An enlarged coronary sinus on echocardiography should raise suspicion of PLSVC. The presence of PLSVC is significant when placing devices with central venous access.

Keywords

• persistent left vena cava
• atrial septal defect
• coronary sinus