N. Marsden, Birmingham Children's Hospital, UK

A left-sided superior vena cava is a common anomaly of the intrathoracic venous system occurring in approximately 1 in 200 individuals in the general population 1.  It is ten times as frequently encountered in individuals with other congenital cardiac abnormalities 2.  It is therefore of particular relevance to anaesthesia in those hospitals in which this patient group is concentrated, i.e. paediatric cardiothoracic centres.

Most patients with a left-sided superior vena cava will be asymptomatic and it is often discovered as an incidental finding during or following a medical intervention, e.g. central venous cannulation, thoracic imaging.  There are some important safety considerations to consider however 3,4.  Despite a wealth of case reports in the literature, an informal survey of trainees and junior consultants at our hospital indicated a lack of familiarity with the clinical relevance of a left-sided superior vena cava.

We present here a brief summary of the relevant anatomy, the clinical implications and the management of a left-sided superior vena cava, as well as an overview of the current evidence base with respect to central venous cannulation.


  1. Irwin R, Greaves M. Schmitt M. Left superior vena cava: revisited. European Heart Journal - Cardiovascular Imaging. 2012;13:284-291
  2. Fernando R, Johnson S. Inability to Utilize Retrograde Cardioplegia due to a Persistent Left Superior Vena Cava. Case Reports in Anesthesiology. 2017 (Article ID 4671856)
  3. Bader M, Bromley P, Jeter I, Bennett J, Arul S. Central venous catheters in the left-sided superior vena cava: clinical implications. Journal of Paediatric Surgery. 2013;48(2):400-403
  4. Bisoyi S, Jagannathan U, Dash A, Tripathy S, Mohapatra R, Pattnaik N, Sahu S, Nayak D. Isolated Persistent Left Superior Vena Cava: A Case Report and its Clinical Implications. Annals of Cardiac Anaesthesia. 2017;20(1):104-107
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