Korean J Crit Care Med.  2015 Feb;30(1):22-26. 10.4266/kjccm.2015.30.1.22.

Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization

• Lee HJ
• Kim N
• Lee H
• Shim JK
• Song JW

• KMID: 2227696
• DOI: http://doi.org/10.4266/kjccm.2015.30.1.22

Abstract

We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.

Keyword

catheterization, Swan-Ganz; vascular malformations; vena cava, superior

MeSH Terms

Arterial Pressure
Catheterization, Swan-Ganz*
Catheters
Coronary Sinus
Echocardiography
Echocardiography, Transesophageal
Heart Ventricles
Humans
Jugular Veins
Male
Middle Aged
Mitral Valve
Pulmonary Artery
Sternotomy
Vascular Malformations
Veins
Vena Cava, Superior*

Figure

• 

  Fig. 1. Transesophageal echocardiography revealed the presence of the pulmonary artery catheter (white arrow) in the left superior vena cava (A) and coronary sinus (B). LA: left atrium; LV: left ventricle; LSVC: left superior vena cava; TEE: transthoracic echocardiography; CS: coronary sinus.

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  Fig. 2. Postoperative chest x-ray showed the unusual path of the pulmonary artery catheter (white arrows), suggesting that the catheter passed through the right internal jugular vein, bridging vein, left superior vena cava, coronary sinus, right ventricle and pulmonary artery. R: right.

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  Fig. 3. Various presentations of persistent left superior vena cava. LBCV: left brachiocephalic vein; RSVC: right superior vena cava; LSVC: left superior vena cava; RA: right atrium; LA: left atrium.

Reference

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