persistent left superior vena cava
{{Infobox medical condition (new)
| name = Persistent left superior vena cava
| image = Gray505.png
| caption = The (right) superior vena cava (on left) and the left brachiocephalic vein (here labeled as left innominate vein). The left superior vena cava is not shown in this image.
|
| pronounce =
| field =
| synonyms =
| symptoms =
| complications =
| onset =
| duration =
| types =
| causes =
| risks =
| diagnosis =
| differential =
| prevention =
| treatment =
| medication =
| prognosis =
| frequency =
| deaths =
}}
In anatomy, a persistent left superior vena cava is the most common variation of the thoracic venous system.{{cite journal |vauthors=Pahwa R, Kumar A |title=Persistent left superior vena cava: an intensivist's experience and review of the literature |journal=South. Med. J. |volume=96 |issue=5 |pages=528–9 |date=May 2003 |pmid=12911199 |doi=10.1097/01.smj.0000060885.27846.91|s2cid=37083684 }}{{cite journal |vauthors=Gonzalez-Juanatey C, Testa A, Vidan J, etal |title=Persistent left superior vena cava draining into the coronary sinus: report of 10 cases and literature review |journal=Clin Cardiol |volume=27 |issue=9 |pages=515–8 |date=September 2004 |pmid=15471164 |doi=10.1002/clc.4960270909|pmc=6654321 }} It is present in between 0.3% and 0.5% of the population,{{cite book |vauthors=Freedom RM, ((Culham JAG)), ((Moes CAF)) |title=Angiography of Congenital Heart Disease |publisher=Macmillan Publishing |location=New York |year=1984 |url=http://www.learningradiology.com/archives03/COW%20061-Persistent%20Left%20SVC/leftsvccorrect.htm}}{{Citation|last1=Crispi|first1=Fatima|title=92 - Anomalies of Systemic Venous Return|date=2018-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780323445481000929|work=Obstetric Imaging: Fetal Diagnosis and Care (Second Edition)|pages=411–414.e1|editor-last=Copel|editor-first=Joshua A.|publisher=Elsevier|language=en|doi=10.1016/b978-0-323-44548-1.00092-9|isbn=978-0-323-44548-1|access-date=2020-11-16|last2=Martinez|first2=Josep M.|editor2-last=D'Alton|editor2-first=Mary E.|editor3-last=Feltovich|editor3-first=Helen|editor4-last=Gratacós|editor4-first=Eduard|url-access=subscription}}{{Citation|last1=Fligner|first1=Corinne L.|title=2 - Surgical Anatomy for the Implanting Physician|date=2018-01-01|url=http://www.sciencedirect.com/science/article/pii/B9780323401265000021|work=Surgical Implantation of Cardiac Rhythm Devices|pages=13–58|editor-last=Poole|editor-first=Jeanne E.|publisher=Elsevier|language=en|doi=10.1016/b978-0-323-40126-5.00002-1|isbn=978-0-323-40126-5|access-date=2020-11-16|last2=Clark|first2=John I.|last3=Clark|first3=Judy M.|last4=Larson|first4=Lyle W.|last5=Poole|first5=Jeanne E.|editor2-last=Larson|editor2-first=Lyle W.|url-access=subscription}} and is an embryologic remnant that results from a failure to involute.
Presentation
In persistent left superior vena cava, the left brachiocephalic vein does not develop fully and the left upper limb and head and neck drain into the right atrium via the coronary sinus.
In isolation, the variation is considered benign, but is very frequently associated with cardiac abnormalities (e.g. ventricular septal defect, atrioventricular septal defect) that have a significant mortality and morbidity.{{cite journal |vauthors=Berg C, Knüppel M, Geipel A, etal |title=Prenatal diagnosis of persistent left superior vena cava and its associated congenital anomalies |journal=Ultrasound Obstet Gynecol |volume=27 |issue=3 |pages=274–80 |date=March 2006 |pmid=16456841 |doi=10.1002/uog.2704 |s2cid=26364072 |doi-access=free }} It is more frequent in patients with congenital heart defects.{{cite journal |vauthors=Bjerregaard P, Laursen HB |title=Persistent left superior vena cava. Incidence, associated congenital heart defects and frontal plane P-wave axis in a paediatric population with congenital heart disease |journal=Acta Paediatr Scand |volume=69 |issue=1 |pages=105–8 |date=January 1980 |pmid=7368902 |doi=10.1111/j.1651-2227.1980.tb07039.x|s2cid=22657811 }}
The (right) superior vena cava is almost always unaffected by the presence of persistent left superior vena cava.
Diagnosis
If an anomaly is detected during a routine ultrasound, a fetal echocardiogram is performed to determine whether a fetus has the condition.{{Citation|last=Marelli|first=Ariane J.|title=69 - Congenital Heart Disease in Adults|date=2012-01-01|url=http://www.sciencedirect.com/science/article/pii/B9781437716047000695|work=Goldman's Cecil Medicine (Twenty Fourth Edition)|pages=397–409|editor-last=Goldman|editor-first=Lee|place=Philadelphia|publisher=W.B. Saunders|language=en|doi=10.1016/b978-1-4377-1604-7.00069-5|isbn=978-1-4377-1604-7|access-date=2020-11-16|editor2-last=Schafer|editor2-first=Andrew I.|url-access=subscription}} Otherwise, it is often unnoticed unless an extenuating circumstance warrants further examination of the heart, usually much later in life.{{cn|date=January 2021}}
CT and MRI scans in a parasagittal section may show a "pipe" sign where the left superior vena cava occurs.
Treatment
If no other cardiac abnormalities are present, persistent left superior vena cava will not be treated, as it is usually asymptomatic and unharmful. If it drains into the left atrium, then deoxygenated blood enters the circulation to the body, and cyanosis may occur.
References
{{reflist}}
External links
{{Medical resources
| DiseasesDB =
| ICD10 = {{ICD10|Q|26|1|q|20}}
| ICD9 = {{ICD9|747.49}}
| ICDO =
| OMIM =
| MedlinePlus =
| eMedicineSubj =
| eMedicineTopic =
| MeshID =
}}
{{Congenital vascular defects}}