Skip to main content
SpringerLink
Log in

Left superior vena cava: cross-sectional imaging overview

  • CARDIAC RADIOLOGY
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Persistent left-sided superior vena cava (PLSVC) is the commonest systemic venous anomaly in the thorax with a reported prevalence of up to 0.5% in otherwise normal population and up to 10% in patients with congenital heart disease (CHD). In the absence of associated CHD, it is usually asymptomatic, discovered incidentally. It may complicate catheter or pacemaker lead placement. PLSVC typically drains into the right atrium through the coronary sinus. In children with CHD, the presence of a PLSVC may affect the choice of certain surgical procedures. PLSVC is significantly more common in association with situs ambiguous than with situs solitus or inversus, up to 60–70%. In patients with situs ambiguous, the drainage of LSVC is variable, more commonly directly into the atria rather than through the coronary sinus (CS). Rarely, there is a PLSVC draining into the CS with absent right SVC. PLSVC draining into the right atrium via the CS will not usually cause blood shunting between the right and the left sides. However, shunting occurs when PLSVC is associated with unroofed CS, or when it directly drains into the left atrium. With an increased use of CT and MRI for chest and cardiac imaging, PLSVC is being more encountered by radiologists than before. In this article, we will discuss the embryology of PLSVC, its anatomic course and drainage pathways, as well as its clinical relevance and relation to congenital heart disease and viscero-atrial situs.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11

Similar content being viewed by others

References

  1. Sonavane SK, Milner DM, Singh SP et al (2015) Comprehensive imaging review of the superior vena cava. Radiographics 35:1873–1892

    Article  Google Scholar 

  2. Saremi F (2014) Congenital thoracic venous anomalies. In: Saremi F (ed) Cardiac CT and MR for adult congenital heart disease. Springer, New York, pp 573–602

    Chapter  Google Scholar 

  3. Goyal SK, Punnam SR, Verma G, Ruberg FL (2008) Persistent left superior vena cava: a case report and review of literature. Cardiovasc Ultrasound 6:50–53

    Article  Google Scholar 

  4. Ari ME, Doğan V, Özgür S et al (2017) Persistent left superior vena cava accompanying congenital heart disease in children: experience of a tertiary care center. Echocardiography 34:436–440

    Article  Google Scholar 

  5. Tawfik AM, Sobh DM, Ashamallah GA, Batouty NM (2019) Prevalence and types of aortic arch variants and anomalies in congenital heart diseases. Acad Radiol 26:930–936

    Article  Google Scholar 

  6. Sobh DM, Batouty NM, Abdelwahab RM, El-Badrawy A, Tawfik AM (2019) Ductus arteriosus location in relation to aortic arch position, branching pattern, and viscero-atrial situs. Clin Radiol 74:732.e1–732.e8

    Article  CAS  Google Scholar 

  7. Kellman GM, Alpern MB, Sandler MA et al (1988) Computed tomography of vena caval anomalies with embryologic correlation. Radiographics 8:533–536

    Article  CAS  Google Scholar 

  8. Benson RE, Songrug T (2009) CT appearance of persistent left superior vena cava, anomalous right superior pulmonary venous return into the right-sided superior vena cava and a sinus venosus-type atrial septal defect. Br J Radiol 82:e235–e239

    Article  Google Scholar 

  9. Sheikh AS, Mazhar S (2014) Persistent left superior vena cava with absent right superior vena cava: review of the literature and clinical implications. Echocardiography 31:674–679

    Article  Google Scholar 

  10. Kula S, Cevik A, Sanli C et al (2011) Persistent left superior vena cava: experience of a tertiary health-care center. Pediatr Int 53:1066–1069

    Article  Google Scholar 

  11. D’Cruz IA, Shala MB, Johns C (2000) Echocardiography of the coronary sinus in adults. Clin Cardiol 23:149–154

    Article  Google Scholar 

  12. Shah SS, Teague SD, Lu JC, Dorfman AL, Kazerooni EA, Agarwal PP (2012) Imaging of the coronary sinus: normal anatomy and congenital abnormalities. Radiographics 32:991–1008

    Article  Google Scholar 

  13. Rein AJ, Nir A, Nadjari M (2000) The coronary sinus in the fetus. Ultrasound Obstet Gynecol 15:468–472

    Article  CAS  Google Scholar 

  14. Chaoui R, Heling KS, Kalache KD (2003) Caliber of the coronary sinus in fetuses with cardiac defects with and without left persistent superior vena cava and in growth-restricted fetuses with heart-sparing effect. Prenat Diagn 23:552–557

    Article  CAS  Google Scholar 

  15. Ma M, Tan Y, Chen R, Mao Y, Wang B, Zhao B (2018) Comparison of coronary sinus diameter Z-scores in normal fetuses and fetuses with persistent left superior vena cava (PLSVC). Int J Cardiovasc Imaging 34:223–228

    Article  Google Scholar 

  16. Arat ND, Sokmen Y, Golbasi Z (2007) Persistent left superior vena cava with absent right superior vena cava and coronary sinus dilation mimicking a paracardiac mass. Tex Heart Inst J 34:492–493

    PubMed  PubMed Central  Google Scholar 

  17. Postema PG, Rammeloo LA, van Litsenburg R et al (2008) Left superior vena cava in pediatric cardiology associated with extra-cardiac anomalies. Int J Cardiol 123:302–306

    Article  Google Scholar 

  18. Parikh SR, Prasad K, Iyer RN et al (1996) Prospective angiographic study of the abnormalities of systemic venous connections in congenital and acquired heart disease. Catheter Cardiovasc Diagn 38:379–386

    Article  CAS  Google Scholar 

  19. Perles Z, Nir A, Gavri S et al (2013) Prevalence of persistent superior vena cava and association with congenital heart anomalies. Am J Cardiol 112:1214–1218

    Article  Google Scholar 

  20. Pasquini L, Fichera A, Tan T, Ho SY, Gardiner H (2005) Left superior caval vein: a powerful indicator of fetal coarctation. Heart 91:539–540

    Article  CAS  Google Scholar 

  21. Gustapane S, Leombroni M, Khalil A et al (2016) Systematic review and meta-analysis of persistent left superior vena cava on prenatal ultrasound: associated anomalies, diagnostic accuracy and postnatal outcome. Ultrasound Obstet Gynecol 48:701–708

    Article  CAS  Google Scholar 

  22. Corno AF, Festa P (2009) Congenital heart defects. Decision making for surgery. CT-scan and MRI, vol 3. Steinkopff-Verlag, Darmstadt

    Google Scholar 

  23. Tawfik AM, Batouty NM, Zaky MM, Eladalany MA, Elmokadem AH (2013) Polysplenia syndrome: a review of the relationship with viscero-atrial situs and the spectrum of extra-cardiac anomalies. Surg Radiol Anat 35:647–653

    Article  Google Scholar 

  24. Macartney FJ, Zuberbuhler JR, Anderson RH (1980) Morphological considerations pertaining to recognition of atrial isomerism. Consequences for sequential chamber localization. Br Heart J44:657–667

    Article  Google Scholar 

  25. Peoples WM, Moller JH, Edwards JE (1983) Polysplenia: a review of 146 cases. Pediatr Cardiol 4:129–137

    Article  CAS  Google Scholar 

  26. Rubino M, Van Praagh S, Kadoba K, Pessotto R, Van Praagh R (1995) Systemic and pulmonary venous connections in visceral heterotaxy with asplenia. Diagnostic and surgical considerations based on seventy-two autopsied cases. J Thorac Cardiovasc Surg 110:641–650

    Article  CAS  Google Scholar 

  27. Ho VB, Bakalov VK, Cooley M, Van PL, Hood MN, Burklow TR, Bondy CA (2004) Major vascular anomalies in Turner syndrome: prevalence and magnetic resonance angiographic features. Circulation 110:1694–1700

    Article  Google Scholar 

  28. Du L, Xie HN, Zhu YX, Li LJ, Peng R, Zheng J (2014) Fetal persistent left superior vena cava in cases with and without chromosomal anomalies. Prenat Diagn 34:797–802

    Article  Google Scholar 

  29. Sakai C, Yamano T, Miki T et al (2017) Imaging of right-to-left shunt in an adult patient with unroofed coronary sinus with persistent left superior vena cava. Int Heart J 58:1008–1011

    Article  Google Scholar 

  30. Irwin RB, Greaves M, Schmitt M (2012) Left superior vena cava: revisited. Eur Heart J Cardiovasc Imaging 13:284–291

    Article  CAS  Google Scholar 

  31. Agarwal PP, Mahani MG, Lu JC, Dorfman AL (2015) Levoatriocardinal vein and mimics: spectrum of imaging findings. Am J Roentgenol 205:162–171

    Article  Google Scholar 

Download references

Funding

This work received no funding or grants.

Author information

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University Hospital, 12 El-Gomhoreya Street, Mansoura, 35112, Egypt

    Nihal M. Batouty, Donia M. Sobh, Basma Gadelhak, Walaa Mahmoud & Ahmed M. Tawfik

  2. Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Hoda M. Sobh

Authors
  1. Nihal M. Batouty
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donia M. Sobh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Basma Gadelhak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hoda M. Sobh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Walaa Mahmoud
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ahmed M. Tawfik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmed M. Tawfik.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (including name of committee + reference number) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the local institutional review board.

Informed consent

Informed consent was waived by the institutional review board.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Batouty, N.M., Sobh, D.M., Gadelhak, B. et al. Left superior vena cava: cross-sectional imaging overview. Radiol med 125, 237–246 (2020). https://doi.org/10.1007/s11547-019-01114-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-019-01114-9

Keywords

Search

Navigation