Beware of a duplicate superior vena cava

Abstract

A duplicate superior vena cava (SVC) with a persistent left SVC (PLSVC) is present in 0.3% of the population with an incidence as high as 10-11% in patients with congenital heart disease. While a PLSVC is rare and usually asymptomatic, clinicians should be aware of this anomaly during central line placement due to potential complications.  Our case involves a 76-year-old man with end-stage renal disease, on peritoneal dialysis (PD), who was admitted to our hospital for treatment of generalized peritonitis secondary to a descending colon perforation. He underwent left hemicolectomy and removal of an infected PD catheter. During preparation for discharge, he underwent hemodialysis catheter replacement. During the procedure, it was noted that the wire did not traverse the midline. A subsequent venogram with contrast showed a duplicate SVC draining into the coronary sinus. The catheter was inserted into the proximal left SVC and verified with fluoroscopy. One hour later, the patient went into atrial fibrillation and death ensued.  Persistent superior vena cava, if known or suspected, requires additional caution in central venous line placement to avoid potentially fatal complications, such as arrhythmias. Immediate removal and reassessment of an alternative access site should be pursued to avoid secondary complications.