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Levoatriocardinal vein: A comprehensive interventional approach

Mario Giordano, Adriano Caputo, Gianpiero Gaio, Raffaella Marzullo, Marianna Carrozza, Maurizio Cappelli Bigazzi, Maria Teresa Palladino, Maria Giovanna Russo

Levoatriocardinal Vein (LACV) is a rare congenital vascular connection between the left atrium (or a pulmonary vein) and the cardinal venous system. This anomaly is usually associated with left-heart obstructive lesions allowing an adequate decompression of the left-sided heart. However, it may be found isolately or associated to congenital heart diseases without left-heart obstructive lesions. In these cases, the LACV develops a pre-tricuspid left-to-right shunt with consequent right-sided heart dilatation and pulmonary hypertension. The progresses of interventional cardiology allowed to develop various percutaneous strategies to approach these patients. The objective of this review is to highlight the role of interventional cardiology in this rare vascular anomaly and the various feasible strategy to adopt in order to the different settings: from the LACV stenting in the cases with associated left heart obstructive lesions up to the LACV embolization in the cases without associated congenital anomalies and with significant right-sided heart overload.