A 71-year-old female patient with the diagnosis
of gastric cancer was referred to our clinic for
the placement of a port catheter access system.
His medical history was non-specific without
any cardiopulmonary symptoms. Under local
anesthesia and online rhythm monitoring, a totally
implantable venous access device (Venous Port,
Baxter Healthcare Corp., CA, USA) was placed via
the right subclavian vein uneventfully to allow the
administration of chemotherapy. Subsequent control
X-ray revealed that the central venous catheter
(CVC) was not terminating in the right atrium as
expected and the path of CVC was near the aorta
(Figure
1a, b). A blood gas analysis confirmed the
venous concentration. Then, computed tomography
(CT) was performed to visualize the port catheter.
The CT images revealed that the right subclavian
vein was draining into the left persistent superior
vena cava (LPSVC), while there was no evidence for
a right superior vena cava (RSVC) (Figure
2). The
procedure was well-tolerated by the patient and he is
still on chemotherapy uneventfully.
Figure 1: (a) Chest X-ray image.
(b) Three-dimensional image showing
unusual course of central venous
catheter.
Figure 2: Computed tomography images showing venous catheter located in left persistent
superior vena cava.
Although LPSVC represents the most common
congenital venous anomaly of the thoracic systemic
venous return with a rate of 0.3 to 0.5% of individuals
in the general population, coexisting absence of RSVC
is extremely rare.[1] About only 10 to 20% of cases
with LPSVC have this variation. As in our case,
the majority of LPSVC drains into the right atrium
via dilated coronary sinus without resulting in any
hemodynamic consequences. Therefore, most patients
remain asymptomatic.[1-3] However, some authors
demonstrated the viability and safety of LPSVC for
long-term CVC in the setting of both hemodialysis
and chemotherapy in such patients.[1,3,4] Beyond
that, this circumstance remains a challenge during
pacemaker or implantable cardioverter-defibrillator implantation either, as the coronary sinus ostium is not
aligned with the tricuspid orifice as usual. Therefore,
several techniques have been introduced to overcome
this difficulty.[5]
In the presence of LPSVC, irrespective of
the timing of diagnosis (i.e., before or after the
intervention), a comprehensive examination of the
systemic venous return should be performed to assess
the suitability for continued catheterization.[6]
Declaration of conflicting interests
The authors declared no conflicts of interest with respect
to the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.
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