Orthotopic heart transplantation with reconstruction of persistent left superior vena cava

Kazuma Handa,Hiroki Hata,Koichi Toda,Yasushi Yoshikawa,Daisuke Yoshioka,Shigeru Miyagawa,Yoshiki Sawa

doi:10.1186/s40792-020-00834-9

Kazuma Handa, Hiroki Hata + Show 5 more

Open Access

https://doi.org/10.1186/s40792-020-00834-9

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Journal: Surgical case reports	Publication Date: Apr 15, 2020
Citations: 4	License type: open-access

Affiliation: Osaka University

Abstract

BackgroundPersistent left superior vena cava is a not uncommon congenital vascular abnormality. We report a case of heart transplantation with reconstruction of persistent left superior vena cava using a prosthetic vascular graft.Case presentationA 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient’s postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications.ConclusionsReconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.

Highlights

Persistent left superior vena cava is a not uncommon congenital vascular abnormality
We report a case of Persistent left superior vena cava (PLSVC) reconstruction using a prosthetic vascular graft in a patient undergoing heart transplantation
After full median sternotomy and dissection around the heart, we found that, contrary to our expectations, the PLSVC had a larger diameter than the right superior vena cava (SVC)

Summary

Background

Persistent left superior vena cava (PLSVC) is a not an uncommon congenital vascular abnormality (incidence of 0.3–0.5% in the general population and 3–10% among those with congenital heart anomalies) [1]. This condition is usually asymptomatic and does not cause hemodynamic changes [2]. Prior case reports have described orthotopic heart transplantation in patients with PLSVC In some of these cases, simple ligation of the PLSVC was performed, whereas in others the PLSVC was reconstructed [3,4,5].

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