Key result
Transcatheter covered stent successfully seals LSVC-to-LA connection, improving peak VO2 by ~33% at 1 year.
Why the study?
Persistent LSVC connecting to the LA is a rare anomaly with serious clinical implications ranging from cyanosis or paradoxical embolism to overt right heart failure.
Case Report (n=1)
No
Transcatheter covered stent implantation is a feasible and effective treatment for the rare anomaly of LSVC to LA connection.
Background: Persistent left superior vena cava (LSVC) with connection to the left atrium (LA) is a rare anomaly with serious clinical implications. Depending on the direction of flow through the intracardiac shunt, clinical presentation varies from cyanosis or paradoxical embolism to overt right heart failure. Case summary: A 26-year-old man with repaired ventricular septal defect (VSD) during infancy presented with symptoms of progressive exercise intolerance. Cardiac imaging revealed a large defect at the posterior wall of the LSVC above its entry to the coronary sinus (CS), connecting the LSVC with the LA and resulting in diversion of pulmonary venous return to the CS. All pulmonary veins connect normally to the LA. The large left-to-right intracardiac shunt led to significant right ventricular dilation and tricuspid regurgitation. He underwent successful anatomical repair with transcatheter implantation of covered stent from LSVC to the CS, redirecting pulmonary venous return to the LA. At 1 year follow up, his exercise capacity had improved, and cardiac imaging showed complete seal of the LSVC defect without obstruction to pulmonary venous return. Discussion: Our case is the first to our knowledge to report this unusual anatomic variant of LSVC to LA connection, and complete repair by transcatheter treatment. Previous case reports of other forms of LSVC to LA connection were treated with surgery or device occlusion without reconnection of LSVC. This case highlights the efficacy and safety of innovative percutaneous techniques in the management of complex congenital heart lesions. Meticulous procedural planning through 3D modelling and simulation is vital to mitigate the risks of these innovative procedures.
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Duong et al. (2022) conducted a case report in Persistent left superior vena cava with connection to the left atrium (n=1). Percutaneous covered stent placement was evaluated on Anatomical seal of defect and symptomatic improvement. Transcatheter implantation of a covered stent successfully sealed a rare left superior vena cava to left atrium connection, improving peak VO2 from 24.1 to 32 mL/min/kg and reducing RV:LV volume ratio from 2.1 to 1.3 at 1 year.
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