Persistent Left Superior Vena Cava

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A Moment in History

Jean George Bachmann
(1877 – 1959)

French physician–physiologist whose experimental work in the early twentieth century provided the first clear functional description of a preferential interatrial conduction pathway. This structure, eponymically named “Bachmann’s bundle”, plays a central role in normal atrial activation and in the pathophysiology of interatrial block and atrial arrhythmias.

As a young man, Bachmann served as a merchant sailor, crossing the Atlantic multiple times. He emigrated to the United States in 1902 and earned his medical degree at the top of his class from Jefferson Medical College in Philadelphia in 1907. He stayed at this Medical College as a demonstrator and physiologist. In 1910, he joined Emory University in Atlanta. Between 1917 -1918 he served as a medical officer in the US Army. He retired from Emory in 1947 and continued his private medical practice until his death in 1959.

On the personal side, Bachmann was a man of many talents: a polyglot, he was fluent in German, French, Spanish and English. He was a chef in his own right and occasionally worked as a chef in international hotels. In fact, he paid his tuition at Jefferson Medical College, working both as a chef and as a language tutor.

The intrinsic cardiac conduction system was a major focus of cardiovascular research in the late nineteenth and early twentieth centuries. The atrioventricular (AV) node was discovered and described by Sunao Tawara and Karl Albert Aschoff in 1906, and the sinoatrial node by Arthur Keith and Martin Flack in 1907.

While the connections that distribute the electrical impulse from the AV node to the ventricles were known through the works of Wilhelm His Jr, in 1893 and Jan Evangelista Purkinje in 1839, the mechanism by which electrical impulses spread between the atria remained uncertain.

In 1916 Bachmann published a paper titled “The Inter-Auricular Time Interval” in the American Journal of Physiology. Bachmann measured activation times between the right and left atria and demonstrated that interruption of a distinct anterior interatrial muscular band resulted in delayed left atrial activation. He concluded that this band constituted the principal route for rapid interatrial conduction.

Subsequent anatomical and electrophysiological studies confirmed the importance of the structure described by Bachmann, which came to bear his name. Bachmann’s bundle is now recognized as a key determinant of atrial activation patterns, and its dysfunction is associated with interatrial block, atrial fibrillation, and abnormal P-wave morphology. His work remains foundational in both basic cardiac anatomy and clinical electrophysiology.

Sources and references
1. Bachmann G. “The inter-auricular time interval”. Am J Physiol. 1916;41:309–320.
2. Hurst JW. “Profiles in Cardiology: Jean George Bachmann (1877–1959)”. Clin Cardiol. 1987;10:185–187.
3. Lemery R, Guiraudon G, Veinot JP. “Anatomic description of Bachmann’s bundle and its relation to the atrial septum”. Am J Cardiol. 2003;91:148–152.
4. "Remembering the canonical discoverers of the core components of the mammalian cardiac conduction system: Keith and Flack, Aschoff and Tawara, His, and Purkinje" Icilio Cavero and Henry Holzgrefe Advances in Physiology Education 2022 46:4, 549-579.
5. Knol WG, de Vos CB, Crijns HJGM, et al. “The Bachmann bundle and interatrial conduction” Heart Rhythm. 2019;16:127–133.
6. “Iatrogenic biatrial flutter. The role of the Bachmann’s bundle” Constán E.; García F., Linde, A.. Complejo Hospitalario de Jaén, Jaén. Spain
7. Keith A, Flack M. The form and nature of the muscular connections between the primary divisions of the vertebrate heart. J Anat Physiol 41: 172–189, 1907.

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Details: Written by: Efrain A. Miranda, Ph.D.; Published: August 26, 2025; Hits: 6588

LSPV (yellow arrow)

The persistent left superior vena cava (PLSVC) is the most common anatomical variation or anomaly in thoracic anatomy. It is present in 0 .3 to 0 .5% of the general population, but it can be present in 5% to 10% of patients who present some type of congenital cardiac malformation.

The most common presentation of this anomaly is where the PLSVC shares the venous drainage with a normal right superior vena cava. In other cases, the PLSVC is present, but there is total absence of the right superior vena cava. In these cases, the condition can be asymptomatic and can be discovered intra or preoperatively. The PLSVC is shown with a yellow arrow in the accompanying image.

In some cases, the PLSVC opens into the left atrium, causing a right to left cardiac shunt, a condition that is clearly symptomatic.

Embryologically, the development of the (right) superior vena cava begins with a similar counterpart on the left side of the embryo, the left anterior cardinal vein.

The left cardiac horn and left anterior cardinal vein eventually form the coronary sinus while its superior portion obliterates, becomes non- patent and forms the duct of Cuvier and the ligament of Marshall. A portion of the left anterior cardinal vein remains patent and forms the oblique vein of the left atrium (also known as the vein of Marshall). The vein of Marshall is found at the base of the left atrial appendage.

When present, the diameter of the PLSVC is usually quite larger than the average diameter of a normal coronary sinus, and because of the increased flow into the right atrium, the valves of Thebesius (valve at the ostium of the coronary sinus) and the valve of Vieussens (valve found at the end of the great cardiac vein and the start of the normal coronary sinus) are either absent or present with substantial reduction in size.

The history of the discovery and description of the PLSVC is not clear. There are many attributions, but what is undeniable is that the first complete and detailed description of this anatomical variation was done by John Marshall in 1850. The following image shows the original drawing (Plate VI) in his article “On the Development of the Great Anterior Veins Man and Mammalia; including an Account of certain remnants of Fœtal Structure found in the Adult, a Comparative View of these Great Veins the different and an Analysis of their occasional peculiarities in the Human Subject”.

While often clinically silent, PLSVC has important implications for central venous access, pacemaker lead placement, and cardiac surgery.

Personal note: My personal thanks to my good friend and contributor to "Medical Terminology Daily", Dr. Randall K. Wolf for the surgical image.

The following YouTube video by Medical Snippet with animations and drawings by Karthik Easvur provides a detailed description of the formation of the superior vena cava and the PLSVC.

Sources:
1. “Persistent left superior vena cava”. Tyrak KW, Holda J, Holda MK, Koziej M, Piatek K, Klimek-Piotrowska W. Cardiovasc J Afr. 2017 May 23;28(3):e1-e4. doi: 10.5830/CVJA-2016-084. PMID: 28759082; PMCID: PMC5558145.
2. “Persistent left superior vena cava: review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients.” Povoski SP, Khabiri H. World J Surg Oncol. 2011 Dec 28;9:173. doi: 10.1186/1477-7819-9-173. PMID: 22204758; PMCID: PMC3266648.
3. “Absent Right Superior Vena Cava and Persistent Left Superior Vena Cava: An Incidental Finding.” Joshi, Swati, and Ajmer Singh. Annals of Cardiac Anaesthesia, 2nd ed., vol. 26, no. 4, 2023, pp. 433–34, https://doi.org/10.4103/aca.aca_91_23.
4. "Absent right superior vena cava in visceroatrial situs solitus.” Bartram, U., Van Praagh, S., Levine, J. C., Hines, M., Bensky, A. S., & Van Praagh, R. 1983 Am J Card, 52(10), 1262–1268.
5. “Superior vena caval abnormalities: their occurrence rate, associated cardiac abnormalities and angiographic classification in 542 patients” Buirski, G., Jordan, S. C., Joffe, H. S., & Wilde, P. (1986). Cardiovasc Interv Rad, 9(6), 357–362.
6. "Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava" Pate, Y; Gupta, R. Methodist DeBakey Cardiovasc J. 2018. 14:3. 2223-235. DOI: 10.14797/mdcj-14-3-232
7. “On the Development of the Great Anterior Veins Man and Mammalia; including an Account of certain remnants of Fœtal Structure found in the Adult, a Comparative View of these Great Veins the different and an Analysis of their occasional peculiarities in the Human Subject” 1850 Phil Trans R Soc 140:133 - 170. To download this article click here.

Video courtesy of Medical Snippet. The video, animations and drawings are the property of their owners. We encourage viewers to follow and subscribe to their respective YouTube channels.
Image of Marshall's Plate VI modified from the original. Public domain.

Persistent Left Superior Vena Cava

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