Persistent Left Superior Vena Cava in the Setting of Granulicatella adiacens Bactermia and Crescentic Glomerulonephritis

Persistent left superior vena cava (PLSVC) is an anatomic variant that is relatively uncommon in the general population. Lead extraction through PLSVC is extremely rare. Due to unusual anatomy, the procedure carries challenges that require special considerations and careful planning. The authors report a case of lead extraction through a PLSVC with occluded right superior vena cava and highlight the challenges and outcomes of the procedure.

We refer to a very rare case of catheter-related thrombosis in a trauma patient with persistent left and absent right superior vena cava. The role of ultrasound examination in the early diagnosis and treatment of thrombosis in the setting of intensive care unit (ICU) is thoroughly discussed. A 30-year-old man was admitted to the ICU due to multiple trauma. Six days after right internal jugular vein (IJV) catheter insertion, and during a vascular ultrasound examination, an IJV catheter-related thrombosis was diagnosed. Hence, the catheter was removed, and a follow-up ultrasound examination revealed thrombus remnant in the IJV extended into brachiocephalic vein. Subsequently, to exclude a possible extension of the thrombus in the superior vena cava, a transesophageal echocardiography (TEE) examination was performed. The latter revealed a distended coronary sinus and the presence of persistent left superior vena cava (PLSVC). Additionally, TEE examination disclosed thrombus remnant within the PLSVC that was also confirmed with CT venography. Anticoagulant therapy was started thus preventing major complications such as coronary sinus obstruction. This case underlines the role of cardiovascular ultrasound examination as an important tool in performing variety of monitoring in the setting of the ICU.

Pulsed-field ablation (PFA) is a novel technology for atrial fibrillation (AF) ablation that can deliver energy precisely with a lower risk of damage to the surrounding organs. Persistent left superior vena cava (PLSVC) is a congenital variant that can act as a driver of AF, and its isolation may be required in recurrent persistent AF. We describe a case where PFA was used for isolation of the right superior vena cava, PLSVC, and posterior wall of the left atrium.

To describe the prenatal ultrasound characteristics of persistent left superior vena cava (PLSVC) in fetuses and its correlation with related malformations, chromosomal abnormalities, and clinical outcomes. A 10-year retrospective analysis of the clinical and ultrasound data of 898 fetuses diagnosed with PLSVC at our center was conducted. Ultrasound characteristics of PLSVC type were summarised systematically, and incidence rates of abnormalities and pregnancy outcomes of PLSVC types were determined. Diagnosing PLSVC requires the 4CV, 3VV and 3VT views, while auxiliary classification requires parasagittal and innominate vein views. PLSVC ultrasound features include coronary sinus dilation and an additional vascular cross-section on the left side of the pulmonary artery. Types I and II PLSVC involved 94.2% vs. 5.8% of cases, respectively. Type I PLSVC had lower incidence of abnormalities (70.3%) than Type II (100%; p < 0.001) and higher birth rates (63.5% vs. 7.7%; p < 0.001). However, they differed non-significantly in incidence of chromosomal abnormalities (p > 0.05). Of fetuses, 28.0 and 72.0% had isolated and non-isolated PLSVC, respectively. Lower incidence of chromosomal abnormalities occurred in fetuses with isolated PLSVC (7.8%) than that in non-isolated PLSVC (22.0%; p < 0.05). Among the non-isolated group, the subgroup with coexisting cardiac and extracardiac abnormalities had the highest incidence of chromosomal abnormalities (39.5%; p < 0.005). Higher live birth rate occurred for fetuses with isolated PLSVC (99.2%) than for non-isolated PLSVC (45.1%; p < 0.001). Multifaceted prenatal ultrasound is valuable for classifying and categorizing fetal PLSVC. Classifying PLSVC and assessing accompanying abnormalities is key to determining prognosis. Type II or non-isolated PLSVC, when accompanied by intracardiac and extracardiac abnormalities, requires enhanced genetic testing and multidisciplinary management. Contrariwise, Type I or isolated PLSVC has good prognosis.

Peripheral Infusion Therapy in Children Hospitalized in a Reference Hospital in Pediatrics In the Northeast Region of Brazil

Impact on CLABSIs With Bundle Implementation and Staff Education

Persistent left superior vena cava is rare and asymptomatic and is usually discovered incidentally during or after insertion of a central venous catheter. There is uncertainty as to whether or not the catheter should be removed after its malposition resulting in persistent left superior vena cava. We reported an unusual case of a breast cancer patient with a persistent left superior vena cava detected after a peripherally inserted central catheter insertion. The patient had undergone a modified radical mastectomy and needed to insert a peripherally inserted central catheter for chemotherapy. After the peripherally inserted central catheter insertion, the chest X-ray and computed tomography showed that the catheter was located in the persistent left superior vena cava. After an assessment of the persistent left superior vena cava and the catheter tip position, the peripherally inserted central catheter remained in the persistent left superior vena cava for further therapy. To ensure the integrity of the catheter, special follow-ups and tip position observations were carried out. The peripherally inserted central catheter was safe until the end of chemotherapy with no complications. Although the peripherally inserted central catheter tip was located in persistent left superior vena cava, given that the persistent left superior vena cava coexisted with a right superior vena cava with the similar lumen, the peripherally inserted central catheter could be used normally under strict attention.

Persistent left superior vena cava is a congenital variation of the thoracic venous system. Although it is often asymptomatic, its presence can complicate procedures such as central venous access, cardiac device implantation, and cardiothoracic surgery. Reported prevalence data are inconsistent and predominantly derived from populations with underlying cardiac pathology. This study seeks to provide a robust, evidence-based estimate of the prevalence of persistent left superior vena cava in populations not preselected for congenital heart disease. Additionally, it aims to quantify its principal anatomical configurations, including the laterality of the superior vena cava and the presence or absence of a bridging brachiocephalic vein. A systematic search was conducted using PubMed, Google Scholar, Scopus, and Web of Science. Studies documenting the prevalence of persistent left superior vena cava in populations not selected on the basis of congenital heart disease criteria were included. Statistical analysis was carried out using random-effects meta-analytic models. Eighteen studies (n = 169,835 individuals) were included. The pooled prevalence of persistent left superior vena cava was 0.61% (95% CI: 0.38-0.89), with substantial heterogeneity across studies. Subgroup analysis demonstrated higher detection rates in cadaveric investigations (2.08%) compared with interventional studies (0.38%), likely reflecting differences in detection sensitivity. Bilateral superior vena cava was observed in 0.32% of the population, whereas isolated persistent left superior vena cava occurred in 0.10%. A bridging brachiocephalic vein was present in approximately 0.11% of the total population. Although uncommon, persistent left superior vena cava is a reproducible component of thoracic venous morphology with embryological significance. Awareness of its anatomical configurations is important in diagnostic and procedural contexts, especially when a dilated coronary sinus is observed during imaging.

The aim of this study was to assess the prevalence of persistent left superior vena cava (PLSVC) in patients with all types of congenital heart defects and to determine the congenital heart anomalies accompanying PLSVC. The present study is based on a retrospective review of 1205 children who consecutively underwent cardiac catheterization from 2000 to 2007. In order to determine the existence of PLSVC, all the subjects routinely underwent superior vena cava (SVC) injection during angiography at the catheter laboratory of the study center. The prevalence of PLSVC was computed to be 6.1% for the present study population. Transthoracic echocardiography was able to detect PLSVC in 32 children (2.6%) whereas angiography diagnosed PLSVC in 74 children (6.1%). The mean age of the patients with PLSVC was 40.09 ± 50.21 months. A communication between the right and left SVC was determined in 27% of the children who were diagnosed with PLSVC after angiography was performed (20 out of 74). A statistically significant association was present between PLSVC and other congenital cardiac anomalies, including ventricular septal defect (n= 42, 56.8%), atrial septal defect (n= 31, 41.9%), pulmonary stenosis (n= 19, 25.7%), atrioventricular septal defect (n= 10, 13.5%), patent ductus arteriosus (n= 6, 8.1%) and cor triatriatum (n= 3, 4.1%). Transthoracic echocardiography usually visualizes dilated coronary sinus in association with PLSVC. However, SVC injection should be performed in patients undergoing angiography so that morbidity and mortality related with persistent left superior vena cava can be avoided during cardiovascular surgery.

Pulsed-Field Ablation With a Persistent Left Superior Vena Cava

The persistence of left superior vena cava (PLSVC) is the most common congenital anomaly of the venous return system to the heart. Because of the increasing number of patients referred for cardiac resynchronization therapy (CRT) devices implantations, it is expected to encounter this venous anatomic variation. Left ventricular lead placement at an appropriate site is an integral and technically challenging part of successful CRT. In case of cardiac abnormalities could be difficult to achieve an optimal cardiac rhythm management devices implantation. Previous reports in patients with PLSVC highlighted the challenges to achieve an optimal cardiac rhythm device implantation. Recently, a new quadripolar active fixation left ventricular lead is available for CRT device implantation. Hereby we report a case of a device upgrading from dual-chamber pacemaker to CRT with defibrillator backup using the active fixation left ventricular quadripolar lead in a patient with PLSVC and right superior vena cava atresia.

The relevance of the study is conditioned by the problem of implantation of an artificial cardiac pacemaker in atrial fibrillation in patients with tachy-brady syndrome according to the standard scheme related to the presence of a congenital anomaly, such as persistent left superior vena cava. The purpose of the study is to develop an operative method of implantation of a permanent two-chamber pacemaker in patients with tachy-brady syndrome with concomitant pathology of the persistent left superior vena cava. Research methods are the generally accepted clinical and instrumental examination of the patient, including taking anamnesis and a standard cardiological examination, electrocardiography, transthoracic echocardiography, plain radiography, angiocardiographic examination, and multispiral computed tomography, which, along with a general analysis, confirm the presence of tachy-brady syndrome with atrial fibrillation and congenital anomaly in the form of persistent left superior vena cava in patients. The study presents a developed model of surgical implantation of a permanent two-chamber pacemaker to stabilise the condition of patients with atrial fibrillation related to tachy-brady syndrome with concomitant persistent left superior vena cava; the standard implantation mechanism included the introduction of a radiopaque agent to clarify the anatomical structure of the vascular bed, further, its entry from the subclavian veins into the persistent left superior vena cava and into the cavity of the right atrium through the venous coronary sinus was detected, and then a gradual introduction of an endocardial right ventricular electrode was performed into the subclavian vein through the tricuspid valve along with its further positioning in the apex of the right ventricle; therefore, a permanent two-chamber pacemaker can be successfully installed, creating conditions for restoring sinus rhythm in this group of patients, which is of practical importance for the field of medicine (Tab. 3, Fig. 4, Ref. 20). Keywords: atrial fibrillation, persistent left superior vena cava, sick sinus syndrome, pacemaker implantation, cardiac surgery.

Transvenous lead extraction (TLE) is rising in parallel to cardiac implantable electronic device implantations. Persistent left side superior vena cava (PLSVC) is a relatively common anatomical variant in the healthy population; TLE in patients with a PLSVC is rare. Data were collated from 6 European TLE institutes of 10 patients who had undergone lead extraction with a PLSVC. Patient demographics, procedural challenges and outcomes were reported. Ten patients aged 73.4 ± 7.8 years (60% male) underwent TLE of 20 leads (3 left ventricle, 10 right ventricle, 7 right atrium) with dwell time of 82.95 ± 39.1 months. Of the 10 cases, 4 had an infection indication and 5 were biventricular system extractions; 25% of the extracted leads were defibrillator leads. The majority of the procedures were completed in the cardiac catheterization suite (80%) under general anaesthesia (60%) by cardiologists (80%) using a rotational powered sheath (65%). The Tandem approach was used successfully in 3 cases. Complete procedural success was obtained in 100% of cases in the absence of complications within 127.4 ± 74.7 min. There was no 30-day mortality. TLE in PLSVC is feasible albeit rare. Standard extraction techniques in experienced hands are associated with favorable outcomes; the Tandem procedure may be an additional technique to improve the safety and efficacy of TLE in PLSVC.

BackgroundPersistent left superior vena cava is a not uncommon congenital vascular abnormality. We report a case of heart transplantation with reconstruction of persistent left superior vena cava using a prosthetic vascular graft.Case presentationA 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient’s postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications.ConclusionsReconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.

Subjects with persistent left superior vena cava were classified on the basis of the presence and thickness of both superior venae cavae, the anastomotic ramus between the superior venae cavae (anastomotic ramus), and the presence of both azygos veins. Among subjects with persistent left superior vena cava, the percentage of those with weak development of the anastomotic ramus (41.5%) or absence of an anastomotic ramus (35.8%) was 77.3%. In addition, 54.7% of subjects had a left azygos vein. However, 88.7% of subjects had a right azygos vein. In this classification, the most frequently observed types included the presence of both superior venae cavae, an anastomotic ramus, and both azygos veins (20.8%). During student dissection practice sessions performed on 337 cadavers that were carried out from 2002 through 2010, a subject having a left superior vena cava (in 2002) and a subject having both superior venae cavae (in 2003) were detected. The former case was reported previously. The latter case is reported in this paper. The incidence of persistent left superior vena cava was 0.59% (2/337 cadavers).