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Anatomical considerations for the management of a left-sided superior caval vein draining to the roof of the left atrium

Published online by Cambridge University Press:  29 September 2016

Jelena Saundankar ,
Andrew B. Ho ,
Anthony P. Salmon ,
Robert H. Anderson  and
Alan G. Magee
Jelena Saundankar
Affiliation:
Department of Congenital Cardiology, Southampton General Hospital, Southampton, United Kingdom
Andrew B. Ho*
Affiliation:
Department of Congenital Cardiology, Southampton General Hospital, Southampton, United Kingdom
Anthony P. Salmon
Affiliation:
Department of Congenital Cardiology, Southampton General Hospital, Southampton, United Kingdom
Robert H. Anderson
Affiliation:
Department of Congenital Cardiology, Southampton General Hospital, Southampton, United Kingdom
Alan G. Magee
Affiliation:
Department of Congenital Cardiology, Southampton General Hospital, Southampton, United Kingdom
*
Correspondence to: Dr A. Ho, Department of Congenital Cardiology, Southampton General Hospital, Southampton SO16 6YD, United Kingdom. Tel: 023 8077 7222; Fax: 023 8120 4526; E-mail: Andrew.Ho@uhs.nhs.uk
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Abstract

Aims

The pathophysiological entity of a persisting left-sided superior caval vein draining into the roof of the left atrium represents an extreme form of coronary sinus de-roofing. This is an uncommon, but well-documented condition associated with systemic desaturation due to a right-to-left shunt. Depending on the size of the coronary ostium, the defect may also present with right-sided volume loading. We describe two patients, both of whom presented with desaturation, and highlight the important anatomical features underscoring management.

Methods and Results

Both patients were managed interventionally with previous assessment of the size of the coronary sinus ostium through cross-sectional imaging. This revealed a restrictive interatrial communication at the right atrial mouth of the coronary sinus in both patients, which permitted an interventional approach, as the residual left-to-right shunt subsequent to closure of the aberrant vessel would be negligible. At intervention, test occlusion of the left superior caval vein allowed assessment of decompressing vessels before successful occlusion using an Amplatzer Vascular Plug.

Conclusions

Persistence of a left superior caval vein draining to the left atrium may be associated with an interatrial communication at the mouth of the unroofed coronary sinus. The ostium of the de-roofed coronary sinus can be atretic, restrictive, normally sized, or enlarged. Careful assessment of the size of this defect is required before treatment. In view of its importance, which has received little attention in the literature to date, we suggest an additional consideration to the classification of unroofed coronary sinus.

Keywords

Congenitalatrial communicationleft superior caval veinstructural heart diseaseinterventional cardiology
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 5 , July 2017 , pp. 846 - 850
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Copyright
© Cambridge University Press 2016 

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