Imaging topography and morphometry of persistent left superior caval vein and its variations, detected on cardiac implantable electronic device implantation

Background: Persistent left superior caval vein (PLSCV) is a rare, anatomically diverse developmental anomaly of systemic veins. Clinically asymptomatic PLSCVs are detected incidentally during medical procedures that utilise systemic veins, such as cardiac implantable electronic device (CIED) placement, and whose successful completion depends on favourable morphometric parameters of these vessels. The aim of this paper was to present topography and morphometry of PLSCV variations encountered during CIED implantation procedures. Materials and methods: We analysed a group of 5,010 patients for detection of PLSCV during de-novo CIED implantation procedures with transvenous lead placement in the years 2003–2015. PLSCVs were detected intraprocedurally based on venographic images illustrating the venous anomaly and its morphometric parameters, and were subsequently confirmed via postoperative diagnostics. Results: PLSCVs were detected in 10 patients (mean age 66.0 ± 14.0 years; 5 females and 5 males), who constituted 0.2% of the analysed group. There were 6 cases of double superior vena cava (DSVC), 3 of which had a brachiocephalic vein (BCV) connection and did not have BCV bridging. Four patients with a PLSCV had right superior vena cava agenesis; this very rare variation is known as ‘single PLSCV’. All of the detected PLSCV variations drained into the right atrium via the coronary sinus. Conclusions: Our data from a period of 13 years illustrate how rare the PLSCV-type venous anomaly is. The three distinct anatomical PLSCV types showed inter-individual morphometric variations. Due to asymptomatic nature of this anomaly, all cases were detected incidentally, during CIED implantation procedures