The study analyzed data from 898 fetuses with prenatally diagnosed persistent left superior vena cava (PLSVC) over 10 years at a single center in China. The diagnosis of PLSVC is made by imaging the heart's four chambers (4CV), three vessels (3VV) and three triangles (3VT), with dilatation of the coronary sinus and another vascular cross-section to the left of the pulmonary artery. Types I and II PLSVC accounted for 94.2% and 5.8% of cases, respectively, with type I having a lower incidence of abnormalities (70.3% vs. 100% for type II; p < 0.001) and a higher birth rate (63.5% vs. 7.7%; p < 0.001). Of the fetuses, 28.0% had isolated PLSVC and 72.0% had non-isolated, with a lower incidence of chromosomal abnormalities in isolated (7.8% vs. 22.0%; p < 0.05). Unisolated PLSVC with cardiac and extracardiac abnormalities had the highest incidence of chromosomal abnormalities (39.5%; p < 0.005), but a higher live birth rate in isolated (99.2% vs. 45.1%; p < 0.001). Multifaceted prenatal ultrasound allows classification of PLSVC, with type II or non-isolated with abnormalities requiring genetic testing and multidisciplinary management, while type I or isolated has a good prognosis.