Congenital anomalies of superior vena cava (SVC) are generally discovered incidentally during central venous catheter (CVC) insertion, pacemaker electrode placement, and cardiopulmonary bypass surgery. Persistent left SVC (PLSVC) is a rare (0.3%) anomaly in healthy subjects, usually asymptomatic, but when present and undiagnosed, it may be associated with difficulties and complications of CVC placement. In individuals with congenital heart anomalies, its prevalence may be up to 10 times higher than in the general population.
In this perspective, awareness of the importance of the incidental finding of PLSV during CVC placement is crucial. To improve knowledge of this rare but potentially dangerous condition, we describe the embryological origin of SVC, its normal anatomy, and possible congenital anomalies of the venous system and of the heart, including the presence of a right to left cardiac shunt. Diagnosis of PLSVC as well as the clinical complications and technical impact of SVC congenital anomalies for CVC placement are emphasized.
WasseHPersistent left superior vena cava: diagnosis and implications for the interventional nephrologist.Semin Dial2006196540–542
2.
CormierMGYedlickaJWGrayRJMoncadaRCongenital anomalies of the superior vena cava: a CT study.Semin Roentgenol198924277–83
3.
DemosTCPosniakHVPierceKLOlsonMCMuscatoMVenous anomalies of the thorax.AJR Am J Roentgenol200418251139–1150
4.
GranataAAndrulliSFioriniFPersistent left superior vena cava: what the interventional nephrologist needs to know.J Vasc Access2009103207–211
5.
SinghBRamsaroopLMaharajJReddiACase of double superior vena cava.Clin Anat2005185366–369
6.
CherianSBRameshBRMadhyasthaSPersistent left superior vena cava.Clin Anat2006196561565
7.
HardeyDWWhiteMSMalloyKPHackettJEReedCCPersistent left superior vena cava: Review of embryologic anatomy and considerations for cardiopulmonary bypass.Cardiovasc Dis198074433–441
8.
NandyKBlairCBJrDouble superior venae cavae with completely paired azygos veins.Anat Rec196515111–9
9.
AlbaySCankalFKocabiyikNYalcinBOzanHDouble superior vena cava.Morphologie20069028839–42
10.
SahaSPaolettiDRobertsonMPersistent left superior vena cava – considerations in fetal, pediatric and adult populations.AJUM20121561–66
11.
MantiniEGrondinCLilleheiWEdwardsJCongenital anomalies involving the coronary sinus.Circulation1966332317–327
12.
LenoxCCZuberbuhlerJRParkSCAbsent right superior vena cava with persistent left superior vena cava: implications and management.Am J Cardiol1980451117–122
13.
CampbellMDeucharDCThe left-sided superior vena cava.Br Heart J1954164423–439
14.
LeibowitzABHalpernNALeeMHIbertiTJLeft-sided superior vena cava: a not-so-unusual vascular anomaly discovered during central venous and pulmonary artery catheterization.Crit Care Med199220811191122
15.
de LevalMRRitterDGMcGoonDCDanielsonGKAnomalous systemic venous connection.Surgical considerationsMayo Clin Proc19755010599–610
16.
BjerregaardPLaursenHBPersistent left superior vena cava.Incidence, associated congenital heart defects and frontal plane P-wave axis in a paediatric population with congenital heart diseaseActa Paediatr Scand1980691105–108
17.
GaynorJWWeinbergPMSprayTLCongenital heart surgery nomenclature and database project: systemic venous anomalies.Ann Thorac Surg2000694)(SupplS70–S76
18.
HsuLFJaïsPKeaneDAtrial fibrillation originating from persistent left superior vena cava.Circulation20041097828–832
19.
HorlitzMSchleyPThielAWolff-Parkinson-White syndrome associated with persistent left superior vena cava.Clin Res Cardiol2006953133–135
20.
BergCKnüppelMGeipelAPrenatal diagnosis of persistent left superior vena cava and its associated congenital anomalies.Ultrasound Obstet Gynecol2006273274–280
21.
CaruselliMPiattelliniGCamillettiGGirettiRPagniRPersistent left superior vena cava in pediatric patients.J Vasc Access2009103219–220
22.
GoyalSKPunnamSRVermaGRubergFLPersistent left superior vena cava: a case report and review of literature.Cardiovasc Ultrasound20086150
23.
SarodiaBDStollerJKPersistent left superior vena cava: case report and literature review.Respir Care2000454411–416
24.
HansonEWHannanRLBaumVCPulmonary artery catheter in the coronary sinus: implications of a persistent left superior vena cava for retrograde cardioplegia.J Cardiothorac Vasc Anesth1998124448–449
25.
ParreiraLFLucasCCGilCCBarataJDCatheterization of a persistent left superior vena cava.J Vasc Access2009103214–215
26.
SchummerWSchummerCFröberRPersistent left superior vena cava and central venous catheter position: clinical impact illustrated by four cases.Surg Radiol Anat2003253-4315–321
27.
RossiUGRigamontiPTichàVPercutaneous ultrasound-guided central venous catheters: the lateral in-plane technique for internal jugular vein access.J Vasc Access201415156–60
28.
BowdleTAComplications of invasive monitoring.Anesthesiol Clin N Am2002203571–588
29.
PovoskiSPKhabiriHPersistent left superior vena cava: review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients.World J Surg Oncol201191173
30.
DinasarapuCRAdigaGUMalikSRecurrent cerebral embolism associated with indwelling catheter in the presence of anomalous neck venous structures.Am J Med Sci20103405421–423
31.
LampertiMBodenhamARPittirutiMInternational evidence-based recommendations on ultrasound-guided vascular access.Intensive Care Med20123871105–1117
32.
RuppSMApfelbaumJLBlittCAmerican Society of Anesthesiologists Task Force on Central Venous Access.Practice guidelines for central venous access: a report by the American Society of Anesthesiologists Task Force on Central Venous AccessAnesthesiology20121163539–573
