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Persistent left superior vena cava in esophageal atresia: a review of 5 cases

Maria Knoblich, Aline Vaz Silva, Catarina Ladeira, Sara Carmo, Rafaela Murinello, Andreia Mascarenhas, Patricia Rodrigues, Paolo Casella.

Serviço de Cirurgia Pediátrica, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE

4th World Congress of Pediatric Surgery, 13 a 16 de Outubro 2013, Berlim.

Background: Esophageal atresia is known to be associated with a variety of additional congenital anomalies in multiple organ systems. Persistent left superior vena cava (PLSVC) is of the most common venous thoracic anomaly occuring in about 0,3% of the general population It is usually asymptomatic. This review was undertaken to characterize the frequency of PLSVC in infants treated in our institution with esophageal atresiaand the surgical approach in this subgroup after 4 cases were diagnosed in the first trimester of 2013.
Methods: A retrospective review of all children treated for esophageal atresia from January 2002 to March 2013 at Hospital Dona Estefânia was undertaken. Charts were reviewed for gestational age, weight, type of atresia, preoperative echocardiogram, associated anomalies, surgical approach and angioresonance for the study of congenital venous anomaly identified at surgery.
Results: Of 103 Children, 5 had PLSVC. Of the 5 cases, none of them had prenatal diagnosis of cardiac malformations. After birth echocardiogram revealed minor intrinsic cardiac malformations in 3 and 1 had renal agenesis with contralateral renal pelvis duplication. All of them underwent angioresonance to characterize the vascular anomaly. All were operated by right thoracotomy and primary anastomosis were performed after ligation of the fistula. No post-operative complications were registered.
Conclusion: In our population PLSVC was not associated with increased incident of cardiac or other malformations. Inspite of the preoperative workup the anomaly was not suspected in any of them. The surgical approach was the same as for the other esophageal atresias with primary anastomosis being possible without increased surgical complications.