Nakayama Takeshi, Kobayashi Shinichiro, Murakami Shunsuke, Enjoji Takahiro, Tetsuo Hanako, Inoue Yusuke, Kosaka Taichiro, Soyama Akihiko, Adachi Tomohiko, Kobayashi Kazuma, Kanetaka Kengo, Eguchi Susumu
Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan.
Surg Case Rep. 2025;11(1). doi: 10.70352/scrj.cr.24-0088. Epub 2025 May 1.
Persistent left superior vena cava (PLSVC), which is asymptomatic and occurs in 0.3%-0.5% of the general population, is typically detected incidentally but can complicate cardiac procedures owing to its potential to cause arrhythmias. This condition involves an additional venous return pathway to the right atrium, which can alter the cardiac anatomy and is associated with other cardiac aortic anomalies.
A 75-year-old male patient required a central venous port for chemotherapy and radiation therapy for mid-thoracic esophageal cancer. Preoperative computed tomography images revealed that the PLSVC ran ventrally to the aortic and left pulmonary arteries, directly communicating with the right atrium. A peripherally inserted central catheter (PICC) port was planned. The catheter tip of the PICC port was placed within the left superior vena cava instead of the more common right superior vena cava, because the appropriate vessels could not be identified in the right upper arm. This anomaly necessitated a review of findings on the preoperative imaging and underscored the importance of early detection through echocardiography and radiographic guidance to prevent procedural complications. Reconstructed three-dimensional images and radiography-guided catheterization support the navigation of PICC port insertion.
PLSVC, which is often asymptomatic, requires careful preprocedural planning and imaging to ensure safe PICC port insertion.
永存左上腔静脉（PLSVC）通常无症状，在普通人群中的发生率为0.3%-0.5%，一般为偶然发现，但因其可能导致心律失常，会使心脏手术变得复杂。这种情况涉及一条额外的通向右心房的静脉回流途径，可改变心脏解剖结构，并与其他心脏主动脉异常相关。
一名75岁男性患者因胸中段食管癌需要置入中心静脉导管进行化疗和放疗。术前计算机断层扫描图像显示，PLSVC走行于主动脉和左肺动脉前方，直接与右心房相通。计划置入经外周静脉穿刺中心静脉导管（PICC）。由于右上臂无法识别合适的血管，PICC导管尖端被置于左上腔静脉而非更常见的右上腔静脉内。这种异常情况需要重新审视术前影像学检查结果，并强调通过超声心动图和影像学引导进行早期检测以预防手术并发症的重要性。三维重建图像和影像学引导下的导管插入术有助于PICC置入的导航。
PLSVC通常无症状，术前需要仔细规划和影像学检查，以确保PICC安全置入。
