Common Thoracic Venous System Anomaly Essay

Common Thoracic Venous System Anomaly Essay

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First described in 1738, persistent left superior vena cava (PLSVC) is present in 0.3% to 0.5% of the general population and has been described as the most common thoracic venous system anomaly (Freeman, Fenster, Weinberger, Buckner, & Lynch, 2012). With the asymptomatic nature of PLSVC it is easily undiagnosed leaving the potential for complications to arise during central venous access, pacemaker insertion, and coronary bypass surgery. Anesthesia providers need to be aware of this anatomic variation and the clinical consequences that may present.
Persistent left superior vena cava occurs in up to 5% to 12% of patients with congenital hearts (Rossi et al., 2015). According to Freeman et al., (2012) 8% of Eisenmenger syndrome and 20% of tetralogy of Fallot patients have suggestion of PLVSC. It has been associated with other congenital heart abnormalities including atrial septal defect, ventricular septal defect, transposition of the great vessels, and anomalous connections of the pulmonary veins (Sohns et al., 2014). Other associated cardiac structural anomalies include bicuspid aortic valve, atresia of the coronary sinus ostium, cor triatriatum, and coarctation of the aorta (Freeman et al., 2012).
During normal embryonic development venous return occurs through two large pairs of veins. Cranial return occurs via the left and right superior cardinal veins, and caudal return via the left and right inferior cardinal veins. At the eighth week of gestation the brachiocephalic vein is formed as a connection between the left and right superior cardinal veins, and the internal jugular veins are formed from the superior cardinal veins. Formation of the right superior vena cava (SVC) occurs from the caudal portion of the right cardi...

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...ggest that using a catheter placed into a PLSVC requires a diagnostic work up including arterial blood gases analysis, echocardiography, and CT to confirm drainage into the RA and a patent innominate vein. The recommendation in the case of PLSVC is right internal jugular or femoral access (Elison et al., 2014). Additional recommendation for patient with PLSVC draining into the left atrium should have an air filter on intravenous lines placed in the left arm to prevent the insertion of air into the systemic circulation (Freeman et al., 2012).
Another clinical complication of PLSVC is inadequate myocardial perfusion during retrograde cardioplegia with cardiopulmonary bypass and antegrade cardioplegia should be used (Rossi et al., 2014). There have been case reports of coronary sinus rupture while gaining access for cardioplegia administration (Edwards & Tak, 2014).

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