Orthotopic heart transplantation in patients with persistent left superior vena cava and agenesis of left brachiocephalic vein.

Persistent left superior vena cava (PLSVC) is an infrequent abnormality. Anatomical variations can be unexpectedly identified during cardiac procedures. Modifications of surgical techniques become a must during these operations, especially during orthotopic heart transplantation. We present two cases of patients with PLSVC and discuss the anatomy, embryology, diagnosis, and modifications in transplant techniques.