Three-Dimensional Modeling of a Pulmonary Artery Catheter in the Coronary Sinus: A Rare Case of Left Persistent Superior Vena Cava and Absence of Right Superior Vena Cava

PULMONARY artery catheters (PACs) provide advanced hemodynamic information in patients undergoing cardiac surgery. 1 Judge O Ji F Fleming N Liu H Current use of the pulmonary artery catheter in cardiac surgery: A survey study. J Cardiothorac Vasc Anesth. 2015; 29: 69-75 Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar Although variable among institutions, close to 40% of patients undergoing coronary or valvular surgery underwent PAC placement in the United States from 2010 to 2018. 2 Brovman EY Gabriel RA Dutton RP Urman RD. Pulmonary artery catheter use during cardiac surgery in the United States, 2010 to 2014. J Cardiothorac Vasc Anesth. 2016; 30: 579-584 Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar ,3 Brown JA Aranda-Michel E Kilic A et al. The impact of pulmonary artery catheter use in cardiac surgery. J Thorac Cardiovasc Surg. 2021; 164: 1965-1973 Abstract Full Text Full Text PDF PubMed Scopus (11) Google Scholar PAC placement is not without risk, the most common complications being hematoma (4%), arterial puncture (3%), infections, and arrhythmias needing intervention. 4 Harvey S Harrison DA Singer M et al. Assessment of the clinical effectiveness of pulmonary artery catheters in management of patients in intensive care (PAC-Man): A randomised controlled trial. Lancet. 2005; 366: 472-477 Abstract Full Text Full Text PDF PubMed Scopus (809) Google Scholar To avoid the most lethal complications associated with PAC placement, an accurate and detailed understanding of vascular anatomy, including recognizing congenital venous anomalies, is of critical importance. 5 Povoski SP Khabiri H. Persistent left superior vena cava: Review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients. World J Surg Oncol. 2011; 9: 173 Crossref PubMed Scopus (92) Google Scholar Left persistent superior vena cava (PLSVC) is the most common congenital thoracic venous anomaly. 6 Azizova A Onder O Arslan S Ardali S Hazirolan T. Persistent left superior vena cava: Clinical importance and differential diagnoses. Insights Imaging. 2020; 11: 1-19 Crossref PubMed Scopus (34) Google Scholar This abnormality can result in anatomic challenges during device placement and increase the risk of potential complications. Stoiser et al. described a patient with a PLSVC discovered only after a difficult PAC placement, and a postprocedural chest X-ray suggested aberrant anatomy. 7 Stoiser B Vorbeck F Kofler J Locker GJ Burgmann H. Placement of a pulmonary artery catheter via a previously unrecognized persistent left superior vena cava. Vasa. 1999; 28: 53-54 Crossref PubMed Scopus (3) Google Scholar Similarly, Aydın et al. described diagnosing a PLSVC on postprocedural chest X-ray after attempting to place a PAC through the left internal jugular vein. 8 Aydın K Tokur ME Ergan B. A rare vascular anomaly during central venous catheterization: A persistent left-sided superior vena cava. Turk Thorac J. 2018; 19: 46-48 Crossref PubMed Scopus (3) Google Scholar In both instances, the authors warned that clinicians should have a heightened sense of suspicion for a PLSVC when placing a PAC from the left-sided vasculature becomes challenging. A case of a 55-year-old patient is reported with a known left PLSVC and undiagnosed absence of a right-sided superior vena cava (SVC) undergoing coronary artery bypass graft surgery, in whom a PAC was placed with difficulty due to the undiagnosed anatomic variation.