Mitral and tricuspid valve surgery in an adult with aberrant left brachiocephalic vein: a case report

Aberrant left brachiocephalic vein (ALBCV), in which the vein passes posterior to the ascending aorta, is a rare vascular anomaly in adults without congenital heart disease. This condition can complicate venous cannulation during cardiac surgery. We report the case of a 78-year-old woman with severe mitral and tricuspid regurgitation. Preoperative imaging revealed an ALBCV joining the superior vena cava near the right atrium. Although the ALBCV was exposed from both sides of the ascending aorta and prepared for potential cannulation, the cardiopulmonary bypass flow rate was maintained using standard bicaval cannulation. Mitral valve replacement, tricuspid annuloplasty, left atrial Maze, and left appendage resection were performed without any complications. Although ALBCV may present challenges during surgery, thorough preoperative recognition and surgical planning allows for successful management. This case underscores the importance of identifying vascular anomalies, such as ALBCV, before cardiac surgery to avoid unexpected complications and ensure optimal outcomes.