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Abstract

A persistent left superior vena cava (LSCV) is a form of anomalous venous drainage of the superior vena cava into the left atrium. We present a case of LSCV and partial anomalous pulmonary venous return (PAPVR) in a patient with progressively worsening dyspnea on exertion. A 57-year-old female with a history of aortic valve stenosis, and tobacco abuse presented with dyspnea on exertion for 4 days. On presentations her vitals were unremarkable except elevated blood pressure and oxygen saturation of 94% on 5L oxygen. Physical exam was pertinent for 3/6 crescendo-decrescendo murmur with a radiation to the right carotid, mild bibasilar crackles, and trace pitting edema in the lower extremity bilaterally. EKG showed normal sinus rhythm without ischemic changes. Echocardiogram showed preserved ejection fraction of 55% and moderately stenosed trileaflet aortic valve with a peak velocity 3.66 m/s and mean gradient 34 mmHg. A bubble study showed left atrium filling before right atrium raising suspicion for PLSVC or PAPVR with no intracardiac shunt. Further work up with heart catheterization as well as CT chest confirmed PLSVC with no coronary sinus dilation. Cardiac MRI (CMRI) showed PLSVC communicating with the coronary sinus with return into the right atrium and a small right-sided SVC (RSVC) draining into the superior right pulmonary vein with return into the left atrium. She remained asymptomatic with medical management for 2 years during regular cardiology follow up.

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