Understanding Persistent Left Superior Vena Cava: A Case Study

Persistent left superior vena cava (PLSVC) is a rare congenital venous anomaly that can manifest as significant cardiovascular complications, including unexplained heart failure. This article explores a recent case of a 45-year-old male patient diagnosed with PLSVC, emphasizing the importance of recognizing vascular anomalies during diagnostic evaluations of heart failure.

On April 1, 2025, the patient presented to Mogadishu Somali-Turkish Training and Research Hospital with progressive symptoms of heart failure, including dyspnea, fatigue, and reduced exercise tolerance. His medical history was unremarkable, with no prior conditions such as hypertension or diabetes. Physical examination revealed an irregular heart rhythm and a dilated coronary sinus during echocardiography, prompting further imaging studies.

As detailed by Dr. Osman Farah Dahir, a cardiologist at the same institution, the patient underwent contrast-enhanced echocardiography and cardiac CT angiography, which confirmed the presence of PLSVC draining into the coronary sinus, coupled with the complete absence of the right superior vena cava (RSVC). This anomaly has a prevalence of approximately 0.3–0.5% in the general population and is often asymptomatic, making its discovery particularly challenging in clinical settings (Azizova et al., 2020, Insights Imaging).

The association between PLSVC and arrhythmias, particularly atrial fibrillation (AF), is clinically significant. Recent studies indicate that myocardial sleeves extending into the PLSVC may act as arrhythmogenic foci, potentially leading to rhythm disturbances (Turagam et al., 2019, J Interv Card Electrophysiol). In this case, the patient developed AF, which necessitated the initiation of anticoagulation therapy and rate control with beta-blockers.

PLSVC is typically diagnosed incidentally, but early detection is crucial as it can lead to severe complications. According to Dr. Ahmed Elmi Abdi, another cardiologist involved in the case, recognizing PLSVC as a potential contributor to arrhythmias allows for targeted imaging and management strategies, reducing the risk of procedural complications (Goyal et al., 2008, Cardiovascular Ultrasound).

The management of AF in patients with PLSVC often involves catheter ablation, with recent advancements in pulsed-field ablation (PFA) showing promising outcomes in controlling arrhythmias (Menè et al., 2024, HeartRhythm Case Rep). This case underscores the importance of comprehensive cardiovascular evaluation in patients presenting with unexplained rhythm disturbances and the need for advanced imaging techniques to facilitate accurate diagnosis and effective treatment plans.

In conclusion, while PLSVC is frequently an incidental finding, the case highlights the critical need for medical professionals to consider vascular anomalies in the differential diagnosis of heart failure. Timely recognition and intervention can significantly improve patient outcomes and prevent the progression of symptoms associated with this rare condition. Further research into PLSVC and its implications on cardiac health is warranted to optimize management strategies and patient care.