Onur IŞIK, İlker MERCAN, Muhammet AKYÜZ, Meltem ÇAKMAK, Barış GÜVEN

Persistent left superior vena cava frequency in congenital heart surgery and its effect on surgical strategy

Aim: Persistent left superior vena cava encompasses a wide range of systemic venous anomalies. Persistent left superior vena cava is relatively infrequent and, under normal circumstances, asymptomatic but may be of clinical importance in cardiac surgery. This study aims to investigate the effect of persistent left superior vena cava on surgical planning. Material and Methods: We included a total of 525 consecutive patients (310 males, 215 females) who underwent open-heart surgery for congenital heart disease. The association of persistent left superior vena cava with congenital anomalies and surgical approaches were recorded. Demographic data and outcome data were retrospectively analyzed. Results: Persistent left superior vena cava was observed in 28 (5.3%) patients. The drainage point of PLSVC was coronary sinus in 23 (82.1%) patients, left atrium in 5 (17.9%) patients. The mean age and weight of the patients were 11.5 months (range, one day to 18 years), 9.3 kg (range, 0.5-65 kg), respectively. Persistent left superior vena cava was obtained in 11 (39.4%) patients with echocardiography, 12 (%42.8) patients with cardiac catheterization and tomography imaging, and 5 (17.8%) patients during surgery. Surgical management of the PLSVC included of temporary occlusion in 17 (60.7%) patients, direct cannulation in 6 (21.5%) patients, Glenn shunt in 2 (7.1%) patients, intracardiac rerouting in 2 (7.1%) patients and ligation in 1 (3.6%) patient. No operative morbidity and complication associated with persistent left superior vena cava were seen. Conclusions: Consequently, persistent left superior vena cava is relatively infrequent, but the surgical team should be aware of this anomaly, its draining points, and possible complications, and it must be kept in mind simple and effective solutions about persistent left superior vena cava.

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1. Corno AF, FETCS F, Alahdal SA, Das KM. Systemic venous anomalies in the Middle East. Front Pediatr 2013;1:1.
2. Gandy K, Hanley F, Management of systemic venous anomalies in the pediatric cardiovascular surgical patient. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2006;63-74.
3. Batouty NM, Sobh DM, Gadelhak B, et al. Left superior vena cava: cross-sectional imaging overview. Radiol Med 2020;125:237-46.
4. Bouimetarhan L, Radouane B, El JF, Amil T. Persistence of left superior vena cava. Presse Med 2019;48:470-2.
5. Arslan D, Cimen D, Guvenc O, Oran B. The Anomalies of Systemic Venous Connections in Children with Congenital Heart Disease. European J General Med 2014;11:33-7.
6. Kula S, Cevik A, Sanli C, et al. Persistent left superior vena cava: experience of a tertiary health-care center. Pediatr Int 2011;53:1066-9.
7. Minniti S, Visentini S, Procacci C. Congenital anomalies of the venae cavae: embryological origin, imaging features and report of three new variants. Eur Radiol 2002;12:2040-55.
8. Sarodia BD, Stoller JK. Persistent left superior vena cava: case report and literature review. Respiratory care 2000;45:411-6.
9. Postema PG, Rammeloo LA, van Litsenburg R, et al. Left superior vena cava in pediatric cardiology associated with extracardiac anomalies. Int J Cardiol Heart Vasc 2008;123:302-6.
10. Aguilar JM, Rodríguez-Serrano F, Ferreiro-Marzal A, et al. Left superior vena cava draining into the left atrium: clinical entities, diagnosis and surgical treatment. Arch Cardiovasc Dis 2019;112:135-43.
11. Leschka S, Oechslin E, Husmann L, et al. Pre-and postoperative evaluation of congenital heart disease in children and adults with 64-section CT. Radiographics 2007;27:829-46.
12. Erol I, Cetin II, Alehan F, et al. Brain abscess associated with isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. Cardiovasc Intervent Radiol 2006;29:454-6.
13. Ootaki Y, Yamaguchi M, Yoshimura N, et al. Unroofed coronary sinus syndrome: diagnosis, classification, and surgical treatment. J Thorac Cardiovasc Surg 2003;126:1655-6.
14. Cannavale G, Higgins CB, Ordovas KG. Unroofing the diagnosis. Int J Cardiovasc Imaging 2010;26:841-2.
15. Recto MR, ßHenry Sadlo M, Sobczyk WL. Rare Case of Persistent Left Superior Vena Cava to Left Upper Pulmonary Vein: Pathway for Paradoxical Embolization and Develop. J Invasive Cardiol 2007;19:313-6.
16. Lin MC, Fu YC, Jan SL, et al. Comparison of right atrial pressure and central venous pressures measured at various anatomical locations in children. Acta Paediatr Taiwan2005;46:82-6.
17. Sonavane SK, Milner DM, Singh SP, et al. Comprehensive imaging review of the superior vena cava. Radiographics 2015;35:1873-92.
18. Thangaroopan M, Truong QA, Kalra MK, et al. Rare case of an unroofed coronary sinus: diagnosis by multidetector computed tomography. Circulation 2009;119:518-20.
19. Kong P, Ahmad F. Unroofed coronary sinus and persistent left superior vena cava. Eur J Echocardiogr 2007;8:398-401.
20. Ugaki S, Kasahara S, Fujii Y, Sano S. Anatomical repair of a persistent left superior vena cava into the left atrium. Interact Cardiovasc Thorac Surg 2010;11:199- 201.
21. Rudrappa SC, Aggarwal N, Joshi R, Joshi R. Extracardiac Rerouting of Left Superior Vena Cava to Right Atrium. Semin Thorac Cardiovasc Surg 2019;31:571-2.