P32 PERSISTENT ISOLATED LEFT SUPERIOR VENA CAVA ASSOCIATED WITH BICUSPID AORTIC VALVE

Abstract Persistent left superior vena cava (VCSSP) is the most frequent systemic venous return anomaly. It often occurs during right heart catheterization (0.1%) and is associated with right superior vena cava aplasia in 10 to 33%. It can lead to the development of a left superior venous system mirroring the normal right return. It runs between the pulmonary veins and the left auricle, to join the coronary sinus. Sometimes the coronary sinus does not communicate directly with the right atrium but drains into the VCSS. An increased incidence of arrhythmias has also been reported in the presence of venous drainage abnormalities. Its discovery has implications as it can create difficulties in the insertion of central venous catheters, cardiac surgery, thoracic and PMK implantation.VCSSP in the absence of the right superior vena cava (VCSD) is a rare congenital anomaly. Clinical case An 18–year–old soccer player came to our observation for an episode of presyncope and palpitations during a soccer match. The ECG showed sinus rhythm and incomplete right bundle branch block. The echocardiogram showed a bicuspid aortic valve and significant dilatation of the coronary sinus, with suspicion of persistence of the left superior vena cava. Cardiac MRI showed an isolated persistent left superior vena cava along the left mediastinum and extending it connected with the coronary sinus, which in turn drained into the right atrium. There was no evidence of LGE in the late sequences. Discussion VCSSP does not constitute a hemodynamic problem if isolated. The presence of VCSSP in the absence of right superior vena cava (VCSD) is in itself an occurrence rarely described in the literature. The anomalies most frequently associated with the presence of a VCSSP are the Atrial septal defect of the sinus venosus type and tetralogy of Fallot. Rare cases of association with aortic valve bicuspid have also been reported.In patients with VCSSP and absence of VCSD, the coexistence of impulse formation and impulse conduction disorders associated with histological alterations such as fragmentation and stretching of the specific conduction tissue and of the atrioventricular node has been described. The abnormal development can also induce sinus node alterations resulting in sinus dysfunction. In our case, no conduction anomalies or arrhythmias were described