Chapter 27

1. Left superior vena cava draining in the right atrium
2. Left superior vena cava draining in the left atrium
3. Inferior vena cava draining in the left atrium

    In the case of persistent left superior vena cava, different patterns of draining can be observed: into the brachial cephalic vein, into the coronary sinus (these two situations will not necessarily originate symptomatology and are very often seen during autopsy). The persistent left superior vena cava may at times drain in the left atrium, and the patient in these cases, may have a mild cyanosis. The ECG will be entirely within normal range or showing a mild left ventricular hypertrophy. Engorgement of the left upper part of the mediastinal shadow in the chest x-ray may be present. Angiocardiography is practically the only way to make an accurate diagnosis.
    In the case of the superior or inferior vena cava draining in the left atrium, the clinical picture will be probably the same although the patient most often will be more cyanotic than in the first case. Angiocardiography once again and cardiac catheterization, will make the final diagnosis.
    Inferior vena cava with azygous continuation may be rarely seen but is often associated with cyanotic congenital heart disease and may be present many times in the dextrocardiac syndrome. The inferior vena cava will drain in the azygous system or in the hemiazygous system, producing in each case, fullness of the left or right mediastinal contour in the roentgenogram. A large percentage of the malformations of the vena cava are associated with other more complex congenital deformities.