ISSN 0326-646X
 

 
 
 
 
 
 
 
 

 
 

1024x768

 
 
 
 
 
 

Sumario Vol. 42 - Nº3 Julio - Septiembre 2013

Persistent Left Superior Vena Cava in a Patient
with Cardiac Conduction Abnormality

Delicia I. Gentille Lorente

Servicio de Cardiología, Hospital de Tortosa "Verge de la Cinta". IISPV
C/ Esplanetes 14. (43500) Tortosa, Tarragona, España
E mail

Recibido el 07-JUN-2013 – ACEPTADO después de revisión el 21-JUNIO-2013.

The author declare not having conflicts of interest.
Rev Fed Arg Cardiol. 2013; 42(3): 219-221


Print version Imprimir sólo la columna central

  

Male, 43-year-old, asymptomatic patient, with no relevant history, referred because he had presented sinus bradycardia in the basal electrocardiogram of 50 bpm and right bundle branch block of the His bundle (Figure 1). The physical examination, the chest X-ray and the blood analysis were normal. In echo, dilated coronary sinus of 25 mm was detected (Figure 2*), so Nuclear Magnetic Resonance (NMR) was requested to rule out the existence of persistent left superior vena cava (LSVC). NMR confirmed the presence of double superior vena cava, with the LSVC draining (Figure 3 arrow) into the dilated coronary sinus of 26 mm (Figure 3*),andwith the rest of the study being within normal limits.

Figure 1. Twelve-lead ECG

 

Figure 2. Echocardiogram. RA: Right atrium; LA: Left atrium; RV: Right ventricle; LV: Left ventricle.

 

Figure 3. Nuclear magnetic resonance: RA:  Right atrium. RSVC: Right superior vena cava.

 

The persistence of LSVC constitutes a rare congenital anomaly, with prevalence of 0.3-0.5% in the general population and 2-4% in patients with congenital heart diseases [1], such as atrial and ventricular septal defects, tetralogy of Fallot, aortic coarctation, and pulmonary stenosis. Nevertheless, it is the most frequent chest venous anomaly, with different anatomical variants [2]. In 90% of the cases, LSVC drains into the right atrium through the coronary sinus, which is dilated, and rarely into the left atrium, causing right-left shunt.

In general, these anomalies per se are asymptomatic, a casual finding during an imaging test (CAT, NMR or venography) or during interventionism (catheterization, pacemaker or defibrillator implantation, or surgery). The finding of dilated coronary sinus in echo allows suspecting the existence of LSVC, which is confirmed after injecting an echo contrast agent in the left cubital vein [3]. Persistent LSVC may lead to disorders in the genesis and conduction of the cardiac impulse, since the embryological development of the sinus node, AV node and His bundle is very influenced by the regression of the left cardinal vein, so the persistence of LSVC alters the arrangement of the conduction system and predisposes to bradyarrhythmias [4]. Persistent LSVC has also been associated to the presence of arrhythmias by accessory pathways and intranodal reentry, and if it drains into the left atrium it may present the clinical symptoms subsequent from shunt [3,4]. So, the interest in knowing the presence of this anomaly lies in that ignoring the pattern of cardiac venous return by those that conduct invasive procedures and surgeons, may cause severe complications during the channeling of a central venous access for the implantation of catheters or devices [3,5].

 

 

REFERENCES

  1. Iimura A, Oguch T, Shibata M, et al. Double superior vena cava and anomaly of cardiovascular system with a review of the literature. Okajimas Folia Anat Jpn 2011; 88: 37-42.
  2. Goyal SK, Punnam SR, Verma G, et al. Persistent left superior vena cava: a case report and review of literature. Cardiovasc Ultrasound 2008, 6: 50.
  3. González-Juanatey C, Testa A, Vidan J, et al. Persistent left superior vena cava draining into de coronary sinus: report of 10 cases and literature review. Clin Cardiol 2004; 27: 515-8.
  4. Paparella G, Chierchia G, Sarkozy A. et al. Persistent left superior vena cava in patients treated with His-bundle pacing: trouble or help?. Europace 2008; 10: 1102-4.
  5. Povoski SP, Khabiri H. Persistent 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 Oncol 2011, 9:173.

 

Publication: September 2013

 
Editorial Electrónica
de FAC




 
8vo. Congreso Virtual de Cardiología

1º Setiembre al
30 Noviembre, 2013
 

 
XXXI Congreso Nacional de Cardiología

30-31 Mayo,
1º Junio, 2013
Organiza: Región Patagónica
 

 
Búsquedas
Revista de FAC

gogbut

Contenidos Científicos
y Académicos

gogbut

 

 
Accesos rapidos