Permanent pacemaker implantation in a challenging anatomy: Persistent left superior vena cava
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Abstract
The persistence of the left superior vena cava is one of the most common abnormalities that could affect the thoracic venous return, despite its rare occurrence. It can usually be found as the only or in combination with other congenital cardiac abnormalities. Even though it is usually asymptomatic and it rarely has important consequences on the hemodynamics, it could sometimes represent a serious threat. In this regard, PLSVC often represents an incidental finding during an invasive procedure or imaging. We present an interesting case of a 66-year-old patient, with permanent atrial fibrillation and chronic kidney disease who presented to our clinic for a syncope due to complete atrioventricular block. The implant procedure was marked by the incidental intraprocedural finding of unusual venous anatomy. This anomaly included the absence of the superior vena cava, with the communication of the right brachiocephalic trunk and right subclavian vein with a persistent left superior vena cava which drainage directly into the coronary sinus. The right-side approach, as well as the limitation of using contrast-based venography, due to the kidney disease, made the procedure more difficult, but the final position of an active fixation ventricular lead was successfully achieved with optimal and stable pacing parameters through the formation of a particular curve of the lead stylet. Persistence of the left superior vena cava is a venous anomaly, which is frequently suspicioned at transthoracic echocardiography examination when the examiner found a dilated coronary sinus but diagnosed on the implant table of a cardiac device. These anomalies can pose problems and exponentially increase the procedural time even in experienced hands.
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cardiac pacing, persistent left superior vena cava, coronary sinus implantation technique, venography
2. Ruano CA, Marinho-da-Silva A, Donato P. Congenital thoracic venous anomalies in adults: morphologic MR imaging. Curr Probl Diagn Radiol 2015; 44(4):337–345.
3. Kula S, Cevik A, Sanli C, et al. Persistent left superior vena cava: experience of a tertiary health-care center. Pediatr Int 2011; 53(6):1066–1069.
4. Maki R, Miyajima M, Mishina T, Watanabe A. Left upper pulmonary vein connected to the persistent left superior vena cava and the left atrium. Gen Thorac Cardiovasc Surg 2019; 67(8):723-725.
5. Rao EMM, Paydak H, Mehta J. Right Sided Approach for a Pacemaker Insertion in the presence of Persistent Left Sided Superior Vena Cava: A Pacing Challenge. Clin Med Rev Case Rep 2015; 2:31-32.
6. He H, Li B, Ma Y, Zhang Y, Ye C, Mei C, Liu Y. Catheterization in a patient with end-stage renal disease through persistent left superior vena cava: a rare case report and literature review. BMC Nephrol 2019; 20(1):200-202.
7. Feldman A, Antonelli D, Turgeman Y. Successful right ventricular lead placement using a right ventricular septal stylet in a patient with persistent left superior vena cava. Europace 2013; 15:354-354.
8. Roka A, Merkely B. Dual-chamber pacemaker implantation via both superior vena cavae in a patient with persistent left superior vena cava. Heart Rhythm 2011; 8:1815–1816.
9. Umar F, Alzuwam A, Osman F. Dual-chamber pacemaker in persistent left superior vena cava. Heart 2011; 97:1360-1361.
10. Porcellini S, Rimini A, Biasi S. Pacemaker implantation in a patient with persistent left superior vena cava using a steerable catheter-delivered lead. J Cardiovasc Med 2012; 13:653–655.
11. Pontillo D, Patruno N. Persistent left superior vena cava and pacemaker implantation. World J Cardiol 2013; 5:373–374.
12. Dabrowski P, Obszanski B, Kleinrok A, Kutarski A. Long-term follow-up after pacemaker implantation via persistent left superior vena cava. Cardiol J 2014; 21:413–418.
13. Hassine M, Hamdi S, Chniti G, Boussaada M, Bouchehda N, Mahjoub M. Permanent cardiac pacing in a patient with persistent left superior vena cava and concomitant agenesis of the right-sided superior vena cava. J Arrhythm 2015; 31:326–327.
14. Rizkallah J, Burgess J, Kuriachan V. Absent right and persistent left superior vena cava: troubleshooting during a challenging pacemaker implant:a case report. BMC Res Notes 2014; 7(1):1-4.
15. Klimek-Piotrowska W, Hołda MK, Piątek K, Koziej M, Hołda J. Normal distal pulmonary vein anatomy. Peer J 2016; 4:1579-1579.
16. Elison B, Evans D, Zanders T, Jeanmonod R. Persistent left superior vena cava draining into the pulmonary venous system discovered after central venous catheter placement. Am J Emerg Med 2014; 32(8):943-943.
17. Povoski SP, Khabiri H. Persistent left superior vena cava: review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients. World J Surg Oncol 2011; 9:173-173.
18. Innasimuthu AL, Rao GK, Wsong P. Persistent left-sided superior vena cava -a pacing challenge. Acute Card Care 2007; 9:252-252.
19. Dissmann R, Schröder J, Völler H, Behrens S. Entrapment of pacemaker lead by a large net-like Eustachian valve within the right atrium. Clin Res Cardiol 2006; 95(4):241-243.
20. Li T, Xu Q, Liao HT, Asvestas D, Letsas K.P, Li Y. Transvenous dual-chamber pacemaker implantation in patients with persistent left superior vena cava. BMC Cardiovasc Disord 2019; 19(1):1-6.
21. Sasaki K., Tateishi S, Sawada C. Usefulness of a lead delivery system consisting of a fixed-shaped sheath and a lumenless bipolar lead in a patient with absent right and persistent left superior vena cava: A case report. Indian Pacing Electrophysiol J 2018;18(6):234-236.
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