Limits...
The incidental finding of a persistent left superior vena cava: implications for primary care providers-case and review.

Morgan LG, Gardner J, Calkins J - Case Rep Med (2015)

Bottom Line: Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and is a persistent congenital remnant of the vena caval system from early cardiac development.Given the known association between anomalous venous return and the propensity for cardiac arrhythmias, we review the embryology of PLSVC and the mechanisms by which it leads to conduction abnormalities.We also provide the practitioner with recommendations for certain baseline cardiac observations and suggestions for proper surveillance in hopes that better understanding will reduce unnecessary and potentially harmful testing, premature subspecialty referral, and unneeded patient anxiety.

View Article: PubMed Central - PubMed

Affiliation: Section of Cardiology, Department of Internal Medicine, The Medical College of Georgia at Georgia Regents University and Charlie Norwood VA Medical Center, 1120 15th Street, BBR 6518, Augusta, GA 30912, USA.

ABSTRACT
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and is a persistent congenital remnant of the vena caval system from early cardiac development. Patients with congenital anomalous venous return are at increased risk of developing various cardiac arrhythmias, due to derangement of embryologic conductive tissue during the early development of the heart. Previously this discovery was commonly made during the placement of pacemakers or defibrillators for the treatment of the arrhythmias, when the operator encountered difficulty with proper lead deployment. However, in today's world of various easily obtainable imaging modalities, PLSVC is being discovered more and more by primary care providers during routine testing or screening for other ailments. Given the known association between anomalous venous return and the propensity for cardiac arrhythmias, we review the embryology of PLSVC and the mechanisms by which it leads to conduction abnormalities. We also provide the practitioner with recommendations for certain baseline cardiac observations and suggestions for proper surveillance in hopes that better understanding will reduce unnecessary and potentially harmful testing, premature subspecialty referral, and unneeded patient anxiety.

No MeSH data available.


Related in: MedlinePlus

Venous angiogram showing contrast coursing through the persistent left superior vena cava and merging with the coronary sinus before emptying into the right atrium.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4302353&req=5

fig1: Venous angiogram showing contrast coursing through the persistent left superior vena cava and merging with the coronary sinus before emptying into the right atrium.

Mentions: An 84-year-old man presented for evaluation of dizziness and difficulty with ambulation and was found to have a pulse rate in the 30s. Electrocardiogram (ECG) showed sinus rhythm, complete heart block, and an escape rhythm with left bundle branch block morphology. Cardiac catheterization revealed nonobstructive coronary disease. In the CCU, the patient had various arrhythmias including atrial fibrillation with rapid ventricular rate and sinus rhythm with varying degrees of AV block. Due to continued AV block, placement of a permanent pacemaker (PM) was arranged. Preprocedure echocardiogram demonstrated normal left ventricular (LV) size and systolic function left atrial enlargement and a dilated coronary sinus, which at the time were thought to be an incidental finding. However, during implantation of his PM, there was difficulty with passage of the leads from his left subclavian access site. The leads were withdrawn and angiography was performed, showing a persistent left superior vena cava (PLSVC) which drained the left subclavian vein, and joined with the coronary sinus to empty into the right atrium (RA) (Figure 1). Once the anatomy was realized, the PM leads were successfully implanted into the right atrium and right ventricular apex (Figure 2). Review of the previous echocardiographic images confirmed these findings, showing the PLSVC traversing under the left atrium (LA) (Figure 3(a)) and inserting into the dilated coronary sinus (Figure 3(b)). The patient had an uneventful recovery and was discharged to an acute rehabilitation center for continued physical therapy.


The incidental finding of a persistent left superior vena cava: implications for primary care providers-case and review.

Morgan LG, Gardner J, Calkins J - Case Rep Med (2015)

Venous angiogram showing contrast coursing through the persistent left superior vena cava and merging with the coronary sinus before emptying into the right atrium.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4302353&req=5

fig1: Venous angiogram showing contrast coursing through the persistent left superior vena cava and merging with the coronary sinus before emptying into the right atrium.
Mentions: An 84-year-old man presented for evaluation of dizziness and difficulty with ambulation and was found to have a pulse rate in the 30s. Electrocardiogram (ECG) showed sinus rhythm, complete heart block, and an escape rhythm with left bundle branch block morphology. Cardiac catheterization revealed nonobstructive coronary disease. In the CCU, the patient had various arrhythmias including atrial fibrillation with rapid ventricular rate and sinus rhythm with varying degrees of AV block. Due to continued AV block, placement of a permanent pacemaker (PM) was arranged. Preprocedure echocardiogram demonstrated normal left ventricular (LV) size and systolic function left atrial enlargement and a dilated coronary sinus, which at the time were thought to be an incidental finding. However, during implantation of his PM, there was difficulty with passage of the leads from his left subclavian access site. The leads were withdrawn and angiography was performed, showing a persistent left superior vena cava (PLSVC) which drained the left subclavian vein, and joined with the coronary sinus to empty into the right atrium (RA) (Figure 1). Once the anatomy was realized, the PM leads were successfully implanted into the right atrium and right ventricular apex (Figure 2). Review of the previous echocardiographic images confirmed these findings, showing the PLSVC traversing under the left atrium (LA) (Figure 3(a)) and inserting into the dilated coronary sinus (Figure 3(b)). The patient had an uneventful recovery and was discharged to an acute rehabilitation center for continued physical therapy.

Bottom Line: Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and is a persistent congenital remnant of the vena caval system from early cardiac development.Given the known association between anomalous venous return and the propensity for cardiac arrhythmias, we review the embryology of PLSVC and the mechanisms by which it leads to conduction abnormalities.We also provide the practitioner with recommendations for certain baseline cardiac observations and suggestions for proper surveillance in hopes that better understanding will reduce unnecessary and potentially harmful testing, premature subspecialty referral, and unneeded patient anxiety.

View Article: PubMed Central - PubMed

Affiliation: Section of Cardiology, Department of Internal Medicine, The Medical College of Georgia at Georgia Regents University and Charlie Norwood VA Medical Center, 1120 15th Street, BBR 6518, Augusta, GA 30912, USA.

ABSTRACT
Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and is a persistent congenital remnant of the vena caval system from early cardiac development. Patients with congenital anomalous venous return are at increased risk of developing various cardiac arrhythmias, due to derangement of embryologic conductive tissue during the early development of the heart. Previously this discovery was commonly made during the placement of pacemakers or defibrillators for the treatment of the arrhythmias, when the operator encountered difficulty with proper lead deployment. However, in today's world of various easily obtainable imaging modalities, PLSVC is being discovered more and more by primary care providers during routine testing or screening for other ailments. Given the known association between anomalous venous return and the propensity for cardiac arrhythmias, we review the embryology of PLSVC and the mechanisms by which it leads to conduction abnormalities. We also provide the practitioner with recommendations for certain baseline cardiac observations and suggestions for proper surveillance in hopes that better understanding will reduce unnecessary and potentially harmful testing, premature subspecialty referral, and unneeded patient anxiety.

No MeSH data available.


Related in: MedlinePlus