Surgical Strategies for Left Persistent Superior Vena Cava Associated with Other Congenital Heart Anomalies

Between 1985 and 1995, we encountered a left persistent superior vena cava (LPSVC) in 82 (4.7 %) of the patients who underwent open heart surgery because of congenital heart anomalies. LPSVC accompanied most commonly tetralogy of Fallot (20.7 %) and ventricular septal defect (18.2 %). LPSVC drained into the right atrium via coronary sinus in 72 (87.8 %) cases, left atrium directly in 6 (7.3 %) and unroofed coronary sinus in 4 (4.8 %). Twently of these patients needed additional surgical procedure for LPSVC. Ligation of LPSVC was performed on 11 patients. In this group, LPSVC drained into coronary sinus in 6 cases, to left atrium in 2, to unroofed coronary sinus in 3. In 5 patients who underwent total cavapulmonary anastomoses or Fontan procedure, LPSVC was anastomosed to left pulmonary artery as an end-to-side fashion. In 4 patients with LPSVC draining to left atrium. LPSVC was connected to the right atrium via Gore-tex or Hemashield vascular prosthesis. One patient who had ligation of LPSVC and another in whom LPSVC was anastomosed to left pulmonary artery were lost. The patients who had ligation of LPSVC did not show any sign of venous hypertension at their head and upper extremities. In these cases LPSVC was smaller than the right. We observed angiographically that the synthetic grafts were open after 20 months in one of these and after 6 years in another. The patency of the Gore-tex graft was shown echocardiographically in two further patients. We presented surgical strategies for the LPSVC which accompanied congenital heart anomalies.