Fortuitously discovered persistent left superior vena cava in young competitive athletes: Clinical implications of sports physicians

This report describes two athletes with persistent left superior vena cava (PLSVC) accidentally identified during preparticipation medical evaluation. The clinical implications of PLSVC for sports physicians are also discussed. A 16-year-old male ice hockey player and an 18-year-old male high-level field hockey player visited our institute for medical evaluation prior to participating in competition. Neither complained of palpitation, faintness or syncope, which would have suggested a possible cardiac rhythm disturbance, or had been informed of any abnormalities in previous physical examinations. Nonetheless, echocardiography revealed dilated coronary sinuses, and venography confirmed PLSVC and, in one case, showed the absence of the right superior vena cava. Electrocardiograms showed the field hockey player to have an ectopic atrial rhythm with left axis deviation of the frontal plane P-wave and the ice hockey player to have normal sinus rhythm. Symptom-limited treadmill testing revealed nothing abnormal, and after explaining the possible rhythm instability and the potential risk associated with cardiac surgery, the subjects were permitted full participation in competitive sports. Although information is scarce, available data on PLSVC suggest it is benign for competitive athletes. Nevertheless, complications arising from other cardiovascular anomalies, from potential cardiac rhythm disturbances, and from cardiac surgery necessitated by major injuries should be considered prior to participation in competitive sports.