Persistent left superior vena cava and absence of innominate vein during coronary artery bypass surgery

Description 

A 56-year-old man presented with acute left-sided chest pain at rest with associated dyspnoea. His heart rate was 35 beats/min and ECG revealed a complete heart block. A temporary cardiac pacing was implemented on the right side via transcutaneous leads. He was also diagnosed with non-ST elevation myocardial infarction due to raised cardiac enzymes and was managed with medical therapy. The pacemaker was removed after 3 days when he reverted to sinus rhythm. Coronary angiogram was subsequently performed and revealed a critically obstructed triple coronary vessel disease. Echocardiography revealed an ejection fraction of 40%, competent valves and normal chamber size. Coronary artery bypass graft (CABG) surgery was performed via median sternotomy. Interestingly, there were no innominate veins identified intraoperatively and a dilated coronary sinus was seen on transoesophageal echocardiography. Cardiopulmonary bypass was initiated following aortic and two-stage right atrial venous cannulation. The heart was cooled and intentionally...

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