[Cardiac transplantation in a patient with a persistent left superior vena cava and an absent right superior vena cava].

Persistent left superior vena cava is the most common congenital venous abnormality of the thorax and has a prevalence of 0.5% among the general population.1 Other related malformations include absent right superior vena cava and presence of a left azygos vein. In these situations, the right side of the head and the right arm drain mainly through the innominate vein in the left superior vena cava which itself drains through an extremely dilated coronary sinus. We describe a 59-year-old man, with a history of smoking, tuberculosis during childhood, and a hiatal hernia, who had dilated cardiomyopathy in functional class III/IV and was waiting for a heart transplant. No evidence of congenital anomaly was observed in the preoperative assessment. During the surgical procedure, the right superior vena cava was found to be absent and the innominate vein was seen to drain into the left superior vena cava, with the vena cava draining into the coronary sinus. Conventional aortic cannulation of the inferior vena cava into the right atrium and selective cannulation of the left superior vena cava were performed. The only surgical variations to the conventional implant technique were as follows: a) the left superior vena cava was selectively cannulated; b) the coronary sinus and its junction in the remaining right atrium were left intact during cardiotomy; and c) the atrioventricular groove of LETTERS TO THE EDITOR