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Persistent Left Superior Vena Cava Draining into the Left Atrium

Persistent Left Superior Vena Cava Draining into the Left Atrium▶ Watch on YouTube — age-restricted, cannot embed here

Imaging findings

A follow-up radiograph reveals an unusual device along the left mediastinal border. A prior CT scan, performed for progressively worsening shortness of breath and exercise intolerance after ASD repair, showed a left superior vena cava (SVC) directly draining into the left atrium. The device seen on radiograph is a vascular plug placed to occlude this anomalous connection.

Key takeaways

While a persistent left SVC typically drains into the right atrium via the coronary sinus, direct drainage into the left atrium is a congenital anomaly that causes a left-to-right shunt. This can be symptomatic and successfully treated with percutaneous vascular plug placement. Residual shunting, possibly from a small atrial septal defect, may persist after occlusion.

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