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Abstract
Failure in regression of fetal left common cardinal vein, commonly referred to as persistent left superior vena cava, is one of the most frequently encountered anomalies of the systemic venous return. We experienced a case of persistent left superior vena cava in a 60-year-old male who presented with exertional dyspnea and intermittent cough for 1 year. We found that the persistent left superior vena cava drained into right atrium via markedly dilated coronary sinus in transthoracic and contrast transesophageal echocardiography. The patient had also interruption of inferior vena cava, confirmed by venogram during right heart catheterization, so that the blood of inferior vena cava drained into left superior vena cava via hemiazygos vein. The patient improved with medical treatment and was discharged.
References
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Fig. 1.
Chest PA shows fibrous and nodular increased densities at the upper lobe of the right lung and markedly enlarged heart.
Fig. 2.
Transthoracic echocardiogram shows markedly dilated coronary sinus(S) lying posterior to the left atrium(LA) in the region of the atrioventricular groove on parasternal long axis(A) and apical view(B). LV: left ventricle. AO: aorta.
Fig. 3.
Transesophageal echocardiogram shows that marked dilated coronary sinus drains into the right atrium, the arrows indicate the direction of flow(A). The coronary sinus is opacified with contrast medium, draining into right atrium (arrow-heads), following left arm venous injection of agitated saline(B). RA: right atrium, RV: right ventricle. LA: left atrium, LV: left ventricle.
Fig. 4.
Radionuclide ventriculogram with Tc99m shows left superior vena cava drains into right atrium via the dilated coronary sinus and absence of right superior vena cava.
Fig. 5.
Radionuclide venography shows interrupted inferior vena cava when radionuclide was injected into veins of both legs.
Fig. 6.
Lateral angiogram shows that the large distended hemiazygos vein drains through the left superior vena cava and coronary sinus into the right atrium and ventricle.
Fig. 7.
Diagram of venous system of the patient. (Hemiaz. V.: hemiazygos vein, I.V.C.: inferior vena cava, L.A.: left atrium, LS.V.C.: left superior vena cava, RA: right atrium, R. Inn. V.: right innominate vein)
Fig. 8.
Variation of persistent left superior vena cava. A. Left superior vena cava drain via the coronary sinus to the right atrium. B. Uncommonly, the right superior vena cava is atretic. C, The coronary sinus is absent and the left superior vena cava drains directly into the left atrium. D. The coronary sinus is absent and there is no communication between the superior venae cavae. A low-lying coronary sinus atrial septal defect is present(Az. V.: azygos vein, C.S: coronary sinus. Hemiaz V.: hemiazygos vein, I.V.C.: inferior vena cava, LA: left atrium. L Inn. V.: left innominate vein. LS.V.C.: left superior vena cava. R.A: right atrium. R. Inn. V.: right innominate vein. R.S.V.C.: right superior vena cava).
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