Persistent PFO occurs in around 20-25% of the adult population.1) PFO has been known to be the cause of transient ischemic attacks (TIA) or stroke. Meta-analyses and observational check details studies indicate that the prevalence of PFO is approximately 3-fold higher in patients with cryptogenic stroke and migraine compared to controls. Conversely, observational evidences indicate a 2-3-fold increased prevalence of migraine and cerebrovascular events in PFO carriers.2) Transcatheter device closure Inhibitors,research,lifescience,medical has been the treatment of choice for these defects. The persistent left superior vena cava (LSVC) is the most common abnormality

of systemic venous return. It has been observed in 0.5% of the general population and in up to 10% of patients with congenital heart disease.3),4) This anomaly is due to an abnormal development of the sinus venosus in the early stages of fetal life. In 92% of cases, drainage occurs in the right atrium; in the remainder of cases, drainage occurs in the left atrium (LA), either directly or through Inhibitors,research,lifescience,medical an unroofed Inhibitors,research,lifescience,medical coronary sinus.5) Combined defect of abnormal drainage of LSVC to left superior pulmonary vein (LSPV) in PFO patients is uncommon, and we report simultaneous device closure

of LSVC with Amplatzer® Vascular Plug II (St. Jude Medical, St. Paul, MN, USA). Case A 37-year-old female patient with chief Inhibitors,research,lifescience,medical complaint of left arm weakness (duration less than 1 minute) and left-sided lip twitching was diagnosed with PFO under evaluation at Myongji Hospital. Laboratory

test results showed normal value of erythrocyte sedimentation rate, C-reactive protein, no abnormality of coagulopathy, and no suspicious sign of vasculitis. While continuation of warfarin treatment Inhibitors,research,lifescience,medical and medication in regards of rhematoid arthritis diagnosed in 2007, she was referred to Pediatrics Cardiology for PFO closure. Brain magnetic resonance imaging showed signs of stroke and transcatheter closure of PFO was scheduled. Contrast echocardiography performed via the left upper extremity prior to the procedure showed sequential filling of the bubble in the LA followed by left ventricle and then through the PFO to the right all atrium (Fig. 1). For further evaluation, heart computed tomography (CT) was performed and an abnormal connection of LSVC to LSPV which drained into LA was diagnosed (Fig. 2). Fig. 1 Agitation saline injection test. On contrast echo conducted on Rt. arm, the enhancement was seen at not only Rt. side of heart, but also Lt. side. Sequential filling of the bubble in the left atrium followed by left ventricle and then through the patent … Fig. 2 Abnormal Drainage of LSVC to LUPV are shown on three dimensional computed tomography. LSVC: left superior vena cava, LUPV: left upper pulmonary vein, RSVC: right superior vena cava.