Persistent Left Superior Vena Cava in a Heart Transplant Recipient’s Native Heart: A Rare Case Diagnosed by Transesophageal Echocardiogram

Arain FD, Sohn J, Graber RG.Semin Cardiothorac Vasc Anesth. 2020 May 26:1089253220922334. doi: 10.1177/1089253220922334. Online ahead of print.PMID: 32456548



Persistent left superior vena cava (PLSVC) is a rare abnormality with incidence reported as 0.3% to 0.5% in the general population and about 10 times higher in patients with congenital heart disease. The diagnosis of PLSVC in native or donor hearts of patients undergoing heart transplants has been reported in surgical journals. However, this rare finding has not been described in similar heart transplant settings in anesthesia literature. This case describes a 44-year-old male orthotopic heart transplant recipient who was incidentally diagnosed with PLSVC in his native heart on transesophageal echocardiogram after a central venous catheter placement. The particular position of the central venous catheter, in our case, raised the suspicion of PLSVC but needed further verification. With the help of images and videos, we demonstrate that transesophageal echocardiogram can be instrumental in diagnosing PLSVC. Furthermore, the case highlights the importance of effectively communicating with the surgeon about such a finding so that the surgical plan can be modified in a timely manner.