Heart 1998;79:509-512 ( May )
Case studies
Reopening of persistent left superior caval vein after
bidirectional cavopulmonary connections
Department of Pediatrics, The University of Toronto
Faculty of Medicine, Division of Cardiology, Department of
Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
Correspondence to: Dr R M Freedom, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G lX8, Canada.
Accepted for publication 19 January 1998
Persistent left superior vena cava (SVC) is a not
uncommon finding in patients with congenital heart disease. This
anatomical variant must be recognised before doing a Glenn anastomosis,
bidirectional cavopulmonary connection or a Fontan-type procedure.
Following these procedures, reopening of a left SVC leading to clinical cyanosis can occur. Five cases are described in whom persisting left
SVCs were excluded before performing a bidirectional cavopulmonary connection or Fontan procedure but (re-)opened after surgery, leading
to cyanosis either by reducing effective pulmonary blood flow
(bidirectional cavopulmonary connection) or by an obligatory right to
left shunt (Fontan). These observations suggest that, embryologically,
the lumen of the left SVC obliterates rather than disappears. Balloon
occlusion angiography of the innominate vein before cavopulmonary
connections or Fontan procedures might improve detection of these
collateral vessels.
© 1998 by Heart
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