Ductus arteriosus aneurysm with persistent left superior vena cava in a neonate: A "Four-star sign" on echocardiography☆

Persistent LSVC is a relatively rare vascular anomaly but important congenital vascular anomaly, and is prevalent in 0.3–1.3% of the population [6,7]. It is the most common variation of the thoracic venous system and an embryologic remnant that results from a failure to regression. This anomaly is mostly commonly observed in isolation and considered benign, but can be associated with congenital heart diseases such as ventricular septal defect, atrioventricular septal defect or pulmonary atresia that have a significant mortality and morbidity [7]. It is usually asymptomatic and is detected when chest X-ray after the placement of a central venous catheter or pacemaker leads is performed or found incidentally by cardiovascular imaging such as transthoracic echocardiography or chest computed tomography performed for unrelated reasons [8]. The potential importance of persistent LSVC for the surgical risk during operation for congenital heart diseases and for instability of the cardiac rhythm is emphasized. Herein, we reported a 3-day-old female newborn had a ductus arteriosus aneurysm with persistent left superior vena cava detected by neonatal echocardiographic screening. Two-dimensional color Doppler mappings show an unusual echocardiographic image of “Four-star sign” that consists of the ascending aorta (AAo), MPA (main pulmonary artery), LSVC and DAA in high parasternal short-axis view, and a big coronary sinus (CS) in modified apical long-axis view. The “Four star” degraded to “Triple star” for follow-up 2 months later