Epidemiology:
Persistent Left Superior Vena Cava (PLSVC) often goes undiagnosed and is believed to be present in only 0.5% of the general population (1). However, the prevalence of PLSVC in persons undergoing pacemaker and/or ICD placement is approximately 4% (2).
Pathophysiology:
PLSVC occurs when the embryologic structure, the left anterior cardinal vein, fails to involute to become the ligament of Marshall. The PLSVC most commonly connects to the coronary sinus, eventually returning blood to the right atrium.
Patients with PLSVC are at increased risk of developing various cardiac arrhythmias for multiple reasons. First, embryologic pacemaker tissues on the right side SVC form the SA node whereas those on the left lose their conduction …show more content…
This less common variant of PLSVC is fixed to prevent possible thromboembolism due to the right to left shunt. Treatment options include minimally invasive procedures such as a trans-catheter occlusion with a vascular plug (8).
Conclusion:
In our case, a 79-year-old with past medical history of CVA, diabetes mellitus, T-cell lymphoma and GERD presented with dysphagia. Throughout her hospital course, chest x-ray with catheterization of what appeared to be a PLSVC was later confirmed by CT of the thorax.
Persistent left superior vena cava is a rare abnormality, present in approximately 0.5% of the general population, resulting from a failure of the left anterior cardiac vein to involute and become the ligament of Marshall. If PLSVC is discovered in an adult, the physician should conduct extensive cardiac review of systems. The patient should then be followed annually with an EKG and if there is any deviation from the patient’s baseline, they should be referred to a cardiologist (4). If there is a prenatal diagnosis of PLSVC it should precipitate an anatomic survey and fetal echocardiography due to its association with cardiac, extra-cardiac and chromosomal abnormalities
Persistent Left Superior Vena Cava (PLSVC) often goes undiagnosed and is believed to be present in only 0.5% of the general population (1). However, the prevalence of PLSVC in persons undergoing pacemaker and/or ICD placement is approximately 4% (2).
Pathophysiology:
PLSVC occurs when the embryologic structure, the left anterior cardinal vein, fails to involute to become the ligament of Marshall. The PLSVC most commonly connects to the coronary sinus, eventually returning blood to the right atrium.
Patients with PLSVC are at increased risk of developing various cardiac arrhythmias for multiple reasons. First, embryologic pacemaker tissues on the right side SVC form the SA node whereas those on the left lose their conduction …show more content…
This less common variant of PLSVC is fixed to prevent possible thromboembolism due to the right to left shunt. Treatment options include minimally invasive procedures such as a trans-catheter occlusion with a vascular plug (8).
Conclusion:
In our case, a 79-year-old with past medical history of CVA, diabetes mellitus, T-cell lymphoma and GERD presented with dysphagia. Throughout her hospital course, chest x-ray with catheterization of what appeared to be a PLSVC was later confirmed by CT of the thorax.
Persistent left superior vena cava is a rare abnormality, present in approximately 0.5% of the general population, resulting from a failure of the left anterior cardiac vein to involute and become the ligament of Marshall. If PLSVC is discovered in an adult, the physician should conduct extensive cardiac review of systems. The patient should then be followed annually with an EKG and if there is any deviation from the patient’s baseline, they should be referred to a cardiologist (4). If there is a prenatal diagnosis of PLSVC it should precipitate an anatomic survey and fetal echocardiography due to its association with cardiac, extra-cardiac and chromosomal abnormalities