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(Circulation. 2002;105:e79.)
© 2002 American Heart Association, Inc.

Images in Cardiovascular Medicine

Persistent Left Superior Vena Cava Demonstrated With Multislice Spiral Computed Tomography

Thomas C. Gerber, MD; Ronald S. Kuzo, MD

From the Division of Cardiovascular Diseases (T.C.G.) and the Department of Radiology (T.C.G., R.S.K.), Mayo Clinic, Jacksonville, Fla.

Reprint requests to Thomas C. Gerber, MD, Division of Cardiovascular Diseases, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL 32224. E-mail gerber.thomas{at}mayo.edu

A 64-year-old man with atypical angina presented for participation in a clinical trial of minimally invasive coronary angiography with use of contrast-enhanced, retrospectively gated multislice spiral computed tomography (Figure). Two of the 12 coronary segments defined by the American Heart Association could not be assessed because of dense calcification; the remaining segments were free of significant obstructions. A persistent left superior vena cava (PLSVC) connected to the coronary sinus was noted incidentally. There were no associated cardiac malformations. A PLSVC connected to the coronary sinus is the most common anomaly of systemic venous return. This anomaly usually requires no treatment unless it is associated with other cardiac malformations. However, it can create problems with procedures that require access to the right ventricle or pulmonary artery or with new therapeutic techniques that make use of the cardiac veins overlying the left ventricle, such as left ventricular pacing or percutaneous in situ coronary venous arterialization.

View larger version (151K): [in this window] [in a new window]   Volume-rendered, 3-dimensional reconstructions of contrast-enhanced multislice spiral computed tomographic scans of the heart. The images are oriented to display the anatomy of the left atrioventricular groove. Top, Cranial aspect; bottom, caudal aspect. Left, Heart of a 64-year-old man with PLSVC that courses in the left atrioventricular groove after crossing anteriorly to the left upper (LUPV) and left lower (LLPV) pulmonary veins and connects to the right atrium via a dilated coronary sinus (CS). A left marginal vein (LMV), a left posterior vein (LPV), and the middle cardiac vein (MCV) drain directly into the PLSVC. A right superior vena cava was present but not opacified during contrast injection from the left antecubital vein, thus ruling out communication between the superior venae cavae. The inferior vena cava (IVC) connects normally to the right atrium. The circumflex coronary artery was very small and is not visible on these renderings. AO indicates ascending aorta; GCV, great cardiac vein; LA, left atrium; LAA, left atrial appendage; LV, left ventricle; PA, pulmonary artery; A, anterior; F, feet; H, head; L, left; P, posterior; and R, right. Right, Heart of a 62-year-old man with normal anatomy of the left atrioventricular groove. The veins draining the LV surface connect to the GCV, which courses in the vicinity of the circumflex coronary artery (LCX). The superior vena cava (SVC) is situated behind and to the right of the AO.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Gerber, T. C. Articles by Kuzo, R. S. Search for Related Content PubMed PubMed Citation Articles by Gerber, T. C. Articles by Kuzo, R. S. Related Collections CT and MRI Cardiac development