Persistent left superior vena cava is an anomalous vein that derives from a malfunction of obliteration of the left common cardinal vein during intrauterine life. The diagnosis can be suggested by a dilated coronary sinus as seen in echocardiography, or other imagistic methods. Due to the lack of hemodynamic impairment, and consequently with few or no symptoms, this vascular anomaly is frequently discovered incidentally. In this brief report we present the case of a 35-year-old male known with a complex congenital cardiovascular malformation that included atrial septum defect, persistent left superior vena cava and anomalous right pulmonary vein drainage in the PLSVC, diagnosed with sinoatrial block that required pacemaker implantation. Due to the patient’s medical history, investigations to decide the best approach needed for pacemaker implantation were performed, including a thoracic CT that incidentally found additional anomalies — the hemiazygos vein draining in PLSVC and the lack of the left brachiocephalic vein.
1. Demos TC, Posniak HV, Pierce KL, Olson MC, Muscato M. Venous anomalies of the thorax. AJR Am J Roentgenol. 2004;182:1139-1150.
2. Povonski 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;232:730-734.
3. Chaithiraphan S, Goldberg E, Wolff W, Jootar P, Grossman W. Massive thrombosis of the coronary sinus as an unusual complication of transvenous pacemaker insertion in a patient with persistent left, and no right superior vena cava. J Am Geriatr Soc. 1974;22:79-85.
4. Goyal SG, Punnam SR, Verma G, Ruberg FL. Persistent left superior vena cava: a case report and review of literature. Cardiovascular Ultrasound. 2008;6:50.
5. Sarodia B, Stoller J et al. Persistent left superior vena cava: case report and literature review. Respir Care. 2000;45(4):411-416.
6. Winter F. Persistent left superior vena cava; survey of world literature and report of thirty additional cases. Angiology. 1954;5(2):90-132.
7. Doig JC, Saito J, Harris L, Downar E. Coronary sinus morphology in patients with atrioventricular junctional reentry tachycardia and other supraventricular tachyarrhythmias. Circulation. 1995;92:436–441.
8. Lentini S, Recupero A. Recognition of persistent left superior vena cava in non-congenital patients undergoing cardiac surgery. Perfusion. 2011;26:347-350.
9. Benson R, Songrug T. CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right sided superior vena cava and a sinus venosus-type atrial septal defect. Br J Radiol. 2009;82(983):e235-e239.
10. Brignole M, Auricchio A, Baron G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34(29):2281-2329.