Inadvertent Coronary Sinus Cannulation During Central Venous Catheter Placement in a Liver Transplant Recipient with Persistent Left Superior Vena Cava: A Case Report.

Persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly and is usually asymptomatic. Central venous catheterization through a PLSVC can be challenging, and inadvertent advancement of catheters into the coronary sinus may result in arrhythmias, perforation, thrombosis, or inaccurate hemodynamic measurements. We report a case of coronary sinus cannulation by a left internal jugular dialysis catheter in a liver transplant recipient with previously unrecognized PLSVC. Initial chest radiography suggested catheter termination within a duplicated left superior vena cava; however, intraoperative transesophageal echocardiography (TEE) demonstrated the catheter tip within the coronary sinus. The catheter was withdrawn under direct echocardiographic guidance, avoiding potential complications. This case highlights the utility of intraoperative TEE for definitive localization of central venous catheters in patients with anomalous thoracic venous anatomy.