Isolated Anomalous Retroaortic Left Brachiocephalic Vein in an Adult Organ Donor

Abstract

nomalous subaortic (retroaortic) left brachiocephalicvein(ASLBV)isarare systemicvenousanomaly [1, 2].We recently encountered ASLBV in an adult organ donorwith normal cardiac anatomy on echocardiogram. Furtherevaluation showed that the left brachiocephalic vein wasmissing from its usual location and that the left superiorvena cava (SVC) was absent. The ASLBV took an unusualretroaortic course as it crossed left lateral and beneath thearch, above the pulmonary artery, and behind theascending aorta to join the SVC near the azygos vein(Fig 1A, arrow). Before donor cardiectomy was performed,the ASLBV was ligated and divided away from the SVC toavoid its narrowing. The technique for implantation in therecipient was unchanged. Although the thoracic centralveins could not be evaluated in the absence of computedtomography of the donor’s chest, roentgenology of thechest showed an unusual course of the left central linecatheter (Fig 1B, arrow).Although ASLBV is rare and in itself is asymptomatic,recognition is important to avoid misinterpretation [2] andto plan any intervention. Difficulty may be encounteredduring insertion of a central venous catheter through theleft jugular or subclavian approach. Moreover, the lowerinsertion of the ASLBV into the SVC requires carefulevaluation to choose an appropriate, more caudal SVCcannulation site.