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Tang Z, Teng Y, Li J, Du X, Xiao J, Tang G. Left upper lung cancer with persistent left superior vena cava and left azygos vein: a case report. J Cardiothorac Surg 2020; 15:254. [PMID: 32928265 PMCID: PMC7490884 DOI: 10.1186/s13019-020-01278-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023] Open
Abstract
Background With the popularization of thoracoscopic surgery, more and more macrovascular malformations have been reported. Understanding some vascular malformations with relatively fixed anatomical site and their range of drainage could avoid severe complications during the surgery. Persistent left superior vena cava (PLSVC) is a common thoracic vascular malformation, and is always combined with other cardiovascular dysplasia. As for the patient with upper left lung cancer in this case, he had PLSVC and left azygos vein, and non-metastatic enlargement of the lymph nodes at the same time, which had influenced the decisions on surgery and treatment. We made a summary of experience regarding this. Case presentation A 46-years-old male patient, his CT found a space-occupying lesion in the superior lobe of the left lung. The chest CT showed that the patient had PLSVC and left azygos vein, and multiple enlarged lymph nodes in the mediastinum. The patient received thoracoscopic upper left lung lobectomy and lymph node dissection. It was discovered that the left azygos vein had a concealed form, which influenced the lymph node dissection. The post-surgery pathology showed that there was squamous cell carcinoma in the upper left lung (pT2bN0M0 p Phase IIA) and no cancer metastasis with the lymph nodes. The patient had a good post-surgery recovery. Conclusions PLSVC is not rare, and is always combined with other vascular malformations. If discovering PLSVC before surgery, we suggest completing chest enhanced CT and vascular reconstruction, to find out other cardiovascular malformations that may exist. Left azygos vein is a rare vascular malformation, but it has a relatively fixed anatomical site, and always co-exists with PLSVC, therefore, understanding anatomy of left azygos vein is good for preventing accidental damage. Especially when performing surgery above the left pulmonary artery trunk, attention shall be paid to preventing damage to the left azygos vein. In addition, as for the patient with the diagnosis of lung cancer before surgery, it is not reliable to judge whether there is metastasis or not merely according to the size of the lymph nodes, instead, PET-CT or needle biopsy is recommended.
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Miyazaki A, Negishi J, Hayama Y, Tsuda E, Yamada O, Ichikawa H, Uemura H, Ohuchi H. Etiology of atrial fibrillation in patients with complex congenital heart disease - for a better treatment strategy. J Cardiol 2020; 76:438-445. [PMID: 32703716 DOI: 10.1016/j.jjcc.2020.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/05/2020] [Accepted: 05/27/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The demographics of patients with congenital heart disease (CHD) and atrial fibrillation (AF) differ significantly from the general population. The etiology and treatment strategy for AF in CHD patients have been investigated but are to date inconclusive. METHODS To determine the etiology of AF in CHD and to seek a better treatment strategy, we retrospectively evaluated the atrial overload in 42 complex CHD cases with normal atrial arrangements and AF (age 25; range, 9-66 years) and the impact of a reduction in the atrial overload on the atrial rhythm. RESULTS Cardiac defect diagnoses varied, with 17% of the patients having a persistent left superior vena cava (PLSVC). In regard to the volume overload, the frequencies of an overload in the right atrium (RA), left atrium (LA), or both, were 50 %, 23%, and 10%, respectively (p = 0.015). Other sustained supraventricular tachycardias were observed in 29 patients (69%) before and after the onset of AF. Among these 29 patients, 26 had intra-atrial reentrant tachycardia. Fifteen patients (36%), 10 of whom had chronic AF, died during the follow-up including 3 with arrhythmias and 10 because of heart failure. Fourteen (33%) patients had no AF at the last follow-up due to medical interventions, 8 of which underwent solely an RA-sided catheter ablation and/or surgical RA overload reduction. CONCLUSIONS AF in complex CHD with a normal atrial arrangement correlates with a higher RA-sided overload than an LA-sided and exhibits a high incidence of PLSVCs, high comorbidity of intra-atrial reentrant tachycardias, and high mortality rate. In a substantial number of patients, RA-sided interventions were effective in controlling AF. To effectively manage AF in complex CHD it is essential to understand each individual's hemodynamics and consider hemodynamic interventions.
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Persistent left superior vena cava with absent right superior vena cava in adults: CT and clinical findings. Jpn J Radiol 2020; 38:1046-1051. [PMID: 32666181 DOI: 10.1007/s11604-020-01013-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Persistent left superior vena cava (PLSVC) with absent right superior vena cava (ARSVC) is rare. We evaluated CT and clinical findings of adults with ARSVC. MATERIALS AND METHODS Our study included 11 adults with ARSVC (mean age, 63 ± 17 years). We evaluated CT findings of the azygos vein system and coronary sinus (CS) using thin slice data of > 64 MDCT. Arrhythmia and congenial heart disease were assessed. We compared the CS diameters between the ARSVC group and the control group of 120 adults with normal vena cava (mean age, 60 ± 4 years). RESULTS Adults with ARSVC had no azygos vein arch and the hemiazygos vein continued to PLSVCs via the superior intercostal vein. Eight adults had arrhythmia including conduction disturbance and one arrhythmia was associated with atrial septal defect. All adults with ARSVC had dilated CS larger than 11 mm. The mean diameter of the CS in the ARSVC group was 18.4 mm, and that of the control group was 6.8 mm. CS diameter in the ARSVC group was larger than that in the control group (p < 0.001). CONCLUSION Adults with ARSVC had dilated CS and no azygos vein arch. Four adults had conduction disturbance.
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Li Q, Liu Y, Wang M, Yu Z, Gao Y. Peripherally inserted central catheter malposition to a persistent left superior vena cava: A successful case to leave the catheter till the end of chemotherapy. J Vasc Access 2020; 22:987-991. [PMID: 32623949 DOI: 10.1177/1129729820938201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Persistent left superior vena cava is rare and asymptomatic and is usually discovered incidentally during or after insertion of a central venous catheter. There is uncertainty as to whether or not the catheter should be removed after its malposition resulting in persistent left superior vena cava. We reported an unusual case of a breast cancer patient with a persistent left superior vena cava detected after a peripherally inserted central catheter insertion. The patient had undergone a modified radical mastectomy and needed to insert a peripherally inserted central catheter for chemotherapy. After the peripherally inserted central catheter insertion, the chest X-ray and computed tomography showed that the catheter was located in the persistent left superior vena cava. After an assessment of the persistent left superior vena cava and the catheter tip position, the peripherally inserted central catheter remained in the persistent left superior vena cava for further therapy. To ensure the integrity of the catheter, special follow-ups and tip position observations were carried out. The peripherally inserted central catheter was safe until the end of chemotherapy with no complications. Although the peripherally inserted central catheter tip was located in persistent left superior vena cava, given that the persistent left superior vena cava coexisted with a right superior vena cava with the similar lumen, the peripherally inserted central catheter could be used normally under strict attention.
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El Hamriti M, Bergau L, Sommer P, Sohns C. The hidden skills of the cryoballoon: occlusion of cardiac perforation in a patient with persistent left superior vena cava-a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617491 PMCID: PMC7319836 DOI: 10.1093/ehjcr/ytaa056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/31/2019] [Accepted: 02/14/2020] [Indexed: 11/23/2022]
Abstract
Background Cardiac tamponade is one of the most serious complications when performing cardiac interventions. Although most of the patients can be treated effectively using pericardiocentesis, urgent surgery can be necessary in case of continuous bleeding and patients’ haemodynamic impairment. Case summary With this unique clinical case report we describe an acute endovascular occlusion of a cardiac perforation utilizing the inflated 28 mm cryoballon at the transseptal puncture site close to the superior part of the coronary sinus ostium in a patient with persistent left superior vena cava (PLSVC) and severe post-procedural tamponade. Prior to this maneuver, 1200 mL of haemorrhagic effusion has been aspirated. Forty-five minutes after cryoballoon-guided occlusion we deflated the balloon and no additional blood could be aspirated over the following 20 minutes. Discussion Cryoballon-guided occlusion of the perforation site saved the patient from immediate cardiac surgery and resulted in stable haemodynamic conditions. This bailout approach was transferred from coronary interventions where occlusion of a perforated vessel using balloon devices is a common technique to achieve acute hemostasis.
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Zhang J, Zhang W, Min M, Pan Y. Axillary accessory breast cancer with persistent leftsuperior vena cava: A case report and treatment controversy. Int J Surg Case Rep 2020; 73:71-74. [PMID: 32645595 PMCID: PMC7341053 DOI: 10.1016/j.ijscr.2020.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/21/2020] [Accepted: 05/21/2020] [Indexed: 11/27/2022] Open
Abstract
Accessory breast cancer with persistent left superior vena cava(PLSVC) is rare. The treatments of axillary accessory breast cancer should attract our attention. Patients with accessory breast cancer without breast invasion should undergo local enlarged resection and axillary lymph node dissection (ALND). We recommend routine axillary radiotherapy after accessory breast cancer surgery. It is imperative to organize multi-center accessory breast cancer research.
Introduction Axillary accessory breast cancer and persistent left superior vena cava (PLSVC) are rare clinically. Many controversial treatments for accessory breast cancer are worth discussing and learning. Presentation of the case A 48-year-old woman presented with biopsy histopathology confirmed. Right axillary mass biopsy pathology showed mucinous adenocarcinoma of accessory breast. She concerned that the axillary accessory breast cancer was more likely to metastasize and unsure about whether to remove the breast. She accepted extended right axillary accessory breast resection plus ipsilateral axillary lymph node dissection (ALND) and received chemotherapy. She was found to have a PLSVC before chemotherapy. Discussion Is there a need to remove the breast and perform ALND during axillary accessory breast cancer surgery? Is sentinel lymph node biopsy (SLNB) appropriate for axillary accessory breast cancer surgery? Can negative SLNB for axillary accessory breast cancer avoid ALND? Does accessory breast cancer without axillary lymph node metastasis require local radiotherapy? Does PLSVC impact the use of peripherally inserted central catheters (PICC) tubes during chemotherapy? Patients with accessory breast cancer without breast invasion should undergo local extended resection and ALND. SLNB for accessory breast cancer cannot instead of ALND. We recommend routine axillary radiotherapy after accessory breast cancer surgery. If it is determined that the tip of PICC is not in the coronary sinus of PLSVC, PLSVC does not affect chemotherapy. Conclusion Many treatment strategies for accessory breast cancer require more evidence from evidence-based medicine. It is imperative to conduct multi-center accessory breast cancer research.
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Jheengut Y, Fan B. Intraoperative identification of persistent left superior vena cava with intracavitary electrocardiogram during venous port insertion: A report of eight cases. J Vasc Access 2020; 22:834-839. [PMID: 32546056 DOI: 10.1177/1129729820931308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Persistent left superior vena cava is a rare congenital anomaly, occurring in 0.3% to 0.5% of general population and up to 10% in patients with congenital heart disease. This anomaly is usually discovered incidentally during central venous catheterization from left side. Since 2015, we have identified eight cases of persistent left superior vena cava out of a total of 2637 patients who had left sided venous port insertion in our department. The persistent left superior vena cavae were identified with the aid of intracavitary electrocardiogram. The characteristic finding was an initial negative P-wave (in lead II), followed by a biphasic P-wave pattern during catheter insertion. All the ports worked properly, with a total catheter dwelling time of 2586 days (range: 96-756 days, mean: 323.25 days), and no catheter-related complication was observed. However, because of the paucity of clinical evidence, we should still be prudent in the long-term use of venous ports in persistent left superior vena cava.
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Naqvi SHR, Ahmed I, Ali PS, Alam M, Zab J, Naung Tun H. Two Cases of Cardiac Implantable Electronic Device Placement via Persistent Left Superior Vena Cava. Eur J Case Rep Intern Med 2020; 7:001484. [PMID: 32399440 PMCID: PMC7213826 DOI: 10.12890/2020_001484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is the most common variation of anomalous venous return to the heart and present in 0.1–0.5% of the general population. The left anterior cardinal veins typically obliterate during early cardiac development but failure of involution results in PLSVC. It is an asymptomatic congenital anomaly, usually discovered while performing interventions through the left subclavian vein or during cardiovascular imaging. PLSVC can be associated with cardiac arrhythmias and congenital heart disease. We present two cases of PLSVC: first, a 68-year-old male who presented with complete heart block, for which a temporary pacemaker was initially inserted followed by a permanent pacemaker; second, a 53-year-old female with a history of hypertension and ischemic cardiomyopathy with a left ventricular ejection fraction of 25%, and a survivor of sudden cardiac death, who underwent an implantable cardioverter-defibrillator (ICD) for secondary prevention. Both cases of PLSVC were detected incidentally during the transvenous approach to the heart. PLSVC was suspected by the unusually left medial position of the lead, while cineflouroscopy showed the venous trajectory toward the coronary sinus and drainage into the right atrium. It is technically difficult to cross the wire through the tricuspid valve when coming from the PLSVC and coronary sinus without making a loop in the right atrium, which is known as a wide loop technique. PLSVC is an uncommon anomalous anatomical variant and should be recognized appropriately by specialists who frequently carry out procedures through the left subclavian vein, such as implantation of permanent pacemaker, ICD and cardiac resynchronization therapy. It should also be recognized that wide loop formation of the right ventricular lead in the right atrium is helpful to cross the tricuspid valve and to affix the lead in the right ventricle.
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Shafi I, Hassan AAI, Akers KG, Bashir R, Alkhouli M, Weinberger JJ, Abidov A. Clinical and procedural implications of congenital vena cava anomalies in adults: A systematic review. Int J Cardiol 2020; 315:29-35. [PMID: 32434672 DOI: 10.1016/j.ijcard.2020.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/26/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Although congenital vena cava (CVC) anomalies in adults have implications for surgical and radiological interventions, the literature is scare and disparate. The aim of this systematic review was to assess cardiovascular clinical and procedural implications of CVC anomalies in adults without congenital heart disease. METHODS AND RESULTS We searched PubMed and EMBASE from database conception through October 2018 for English-language studies describing the epidemiology of CVC anomalies or their clinical or procedural implications in humans. Two independent reviewers screened 7093 records and identified 16 relevant studies. We found two major implications of CVC anomalies: 1) congenital inferior vena cava (CIVC) anomalies are associated with a 50-100-fold higher risk of deep venous thrombosis, particularly among younger patients, and 2) persistent left superior vena cava (PLSVC) is associated with a 2-3-fold higher risk of supraventricular arrhythmias. PLSVC also poses technical challenges to cardiovascular electronic device implantation, requiring alterations in surgical approach and lengthening procedure and X-ray exposure times. Due to the large disparity in reported prevalence rates of CIVC anomalies, we performed a meta-analysis of CIVC anomaly prevalence including 8 studies, which showed a weighted prevalence of 6.8% (95% CI, 4.5-9.2%). CONCLUSION These findings challenge the notion that CVC anomalies are rare and asymptomatic in adults. Rather, the literature indicates that CVC anomalies are not uncommon and have important clinical and procedural implications. To further understand the prevalence and implications of CVC anomalies, a robust US population-based study and nationwide registry is warranted in the current era of venous interventions.
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Handa K, Hata H, Toda K, Miyagawa S, Yoshikawa Y, Yoshioka D, Sawa Y. Orthotopic heart transplantation with reconstruction of persistent left superior vena cava. Surg Case Rep 2020; 6:71. [PMID: 32297140 PMCID: PMC7158957 DOI: 10.1186/s40792-020-00834-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent left superior vena cava is a not uncommon congenital vascular abnormality. We report a case of heart transplantation with reconstruction of persistent left superior vena cava using a prosthetic vascular graft. CASE PRESENTATION A 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient's postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications. CONCLUSIONS Reconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.
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Çetin Z, Tuncel F, Erdoğan D, Beger O, Olgunus ZK. Autopsy findings of an isolated persistent left superior vena cava in an intrauterine dead fetus. Surg Radiol Anat 2020; 42:391-395. [PMID: 32047982 DOI: 10.1007/s00276-020-02434-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/03/2020] [Indexed: 01/01/2023]
Abstract
Persistent left superior vena cava (PLSVC) is one of the cardiac system abnormalities with a 0.3-0.5% incidence and caused by inadequate obliteration of the left anterior cardinal vein during embryonic development. Prognosis of PLSVC is generally assumed to be good if it is not accompanied by other cardiac system abnormalities. During the routine ultrasound control of a patient at 25th week of pregnancy at the Obstetrics and Gynecology Department of Mersin University, PLSVC anomaly was detected in an intrauterine fetus. Then, intrauterine death occurred and after removal of the deceased fetus, PLSVC diagnosis was confirmed by autopsy. According to the autopsy findings, right superior vena cava (SVC) and azygos vein were found in normal course. PLSVC opened into the right atrium via enlarged coronary sinus. There was no connection between the two SVCs. On the left side of posterior mediastinum, instead of hemiazygos or accessory hemiazygos veins, a vein symmetrical to azygos was opened into PLSVC, similar to the one on the right. No other cardiac anomaly associated with PLSVC or any other pathology in the other parts of body that could be responsible for death was discovered during autopsy. There was no evidence indicating that PLSVC played any role in intrauterine exitus of the present case. However, as mentioned in the literature, the ectopic beats in the atrium wall of patients with isolated PLSVC and enlarged coronary sinus may lead to pathologies in the conduction system of the heart. Considering the intrauterine death of an isolated PLSVC case associated with cardiac conduction pathologies, we recommend that the common assumption of 'isolated PLSVC is not associated with death' should be reviewed by studies on large series and even intrauterine cases should be closely monitored for cardiac arrhythmia.
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Minsart AF, Boucoiran I, Delrue MA, Audibert F, Abadir S, Lapierre C, Lemyre E, Raboisson MJ. Left Superior Vena Cava in the Fetus: A Rarely Isolated Anomaly. Pediatr Cardiol 2020; 41:230-236. [PMID: 31720744 DOI: 10.1007/s00246-019-02246-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 10/31/2019] [Indexed: 12/20/2022]
Abstract
The frequency of chromosomal anomalies among fetuses with isolated persistent left superior vena cava (PLSVC) is still debated. The objective of the present study was to assess the prevalence of genetic and morphological anomalies identified in fetuses with PLSVC. We conducted a single-center retrospective study including all fetuses diagnosed with a PLSVC between 2010 and 2017. PLSVC was categorized as isolated or associated according to antenatal diagnosis of associated congenital heart defects, hypoplastic aortic isthmus, abnormal venous/arterial connections, and extracardiac anomalies. Among 229 fetuses diagnosed with PLSVC, 39 cases (17%) were strictly isolated and no syndromic/genetic anomaly or aortic coarctation was diagnosed. Seventy-two fetuses had a cardiovascular defect with a rate of genetic anomalies of 22%, 29 had an extracardiac malformation, and 89 had both an extracardiac and a cardiovascular defect. Among fetuses with abnormal development of the arterial/venous system as the only associated anomaly such as aberrant right subclavian artery or absent ductus venosus, 22% had a genetic anomaly. Overall, sixty-five fetuses or infants had a genetic concern, including 23 aneuploidies, 15 pathogenic micro-deletions/duplications, and 5 variants of unknown significance; 12 patients had VACTERL association, and 12 heterotaxy syndrome. Seven infants had an aortic coarctation diagnosed at birth.In conclusion, a thorough prenatal ultrasound examination is paramount, and the identification of variants of the venous/arterial system in addition to PLSVC should raise suspicion for genetic or morphologic abnormalities. Invasive prenatal diagnosis with array-CGH should be offered when PLSVC is non-isolated, after a detailed ultrasound evaluation in a tertiary center.
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Kim YG, Han S, Choi JI, Lee KN, Baek YS, Uhm JS, Shim J, Kim JS, Park SW, Hwang C, Kim YH. Impact of persistent left superior vena cava on radiofrequency catheter ablation in patients with atrial fibrillation. Europace 2019; 21:1824-1832. [PMID: 31578551 DOI: 10.1093/europace/euz254] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/18/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The impact of persistent left superior vena cava (PLSVC) in atrial fibrillation (AF) patients undergoing radiofrequency catheter ablation (RFCA) is not well known. We performed this analysis to evaluate the electrophysiological characteristics of PLSVC and its role in triggering and maintaining AF. METHODS AND RESULTS Patients with AF referred to two tertiary hospitals were screened and patients with PLSVC in pre-RFCA imaging studies were enrolled. Among 3967 patients, PLSVC was present in 36 patients (0.9%). There were four morphological types of PLSVC: type 1, atresia of the right superior vena cava (SVC) (n = 2); type 2A, dual SVCs with an anastomosis between right and left SVCs (n = 15); type 2B, dual SVCs without an anastomosis (n = 16); type 3, PLSVC draining into the left atrium (LA; n = 2); and unclassified in one patient. Thirty-two patients underwent RFCA and electrophysiology study focusing on PLSVC: PLSVC was the trigger of AF in 48.4% of patients and the driver of AF in 46.9% of patients. Cumulatively, PLSVC was a trigger or driver of AF in 22 patients (68.8%). Whether to ablate PLSVC was determined by the results of electrophysiology study, and no significant difference in the late recurrence rate was observed between patients who did and did not have either trigger or driver from PLSVC. CONCLUSION Pre-RFCA cardiac imaging revealed PLSVC in 0.9% of AF patients. This study demonstrated that PLSVC has an important role in initiating and maintaining AF in substantial proportion of patients. Electrophysiology study focusing on PLSVC can help to decide whether to ablate PLSVC.
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Fujibayashi K, Saeki Y, Sawaguchi J, Yasuda Y, Ueno E, Takano S, Fujioka N, Kawai Y, Kajinami K. A case of cardiac resynchronization therapy in a patient with coronary sinus ostial atresia and persistent left superior vena cava. J Cardiol Cases 2019; 21:101-103. [PMID: 32153683 PMCID: PMC7054661 DOI: 10.1016/j.jccase.2019.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/15/2019] [Accepted: 10/26/2019] [Indexed: 12/28/2022] Open
Abstract
Coronary sinus ostial atresia is rare and usually not clinically relevant, but it should be noted in cases of cardiac resynchronization therapy. A rare case of successful left ventricular lead implantation for cardiac resynchronization therapy via the left superior vena cava in a patient with coronary sinus ostial atresia is reported. The persistent left superior vena cava associated with these cases tends to be smaller than usual in its diameter and difficult to identify, since the direction of venous drainage is reversed. Therefore, in the present case, it was useful to use a small-diameter, soft inner catheter as a guiding catheter to perform selective imaging and avoid vascular injury. In addition, it appeared to be important to plan the surgical strategy using prior imaging information, since it would be difficult to obtain the backup needed for lead insertion. 〈 Learning objective: Cardiac resynchronization therapy via the left superior vena cava with coronary sinus ostial atresia is generally possible without problems if prior imaging information is available, such as three-dimensional computed tomography and the venous phase of coronary angiography. It is important to determine whether there is a persistent left superior vena cava before the procedure. Thromboprophylaxis remains controversial in this situation.〉
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Cor triatriatum with Raghib complex in partial atrioventricular septal defect and common atrium: a rare combination. Gen Thorac Cardiovasc Surg 2019; 68:641-643. [PMID: 31250204 DOI: 10.1007/s11748-019-01159-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 06/08/2019] [Indexed: 10/26/2022]
Abstract
Persistent left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect (Raghib complex) is an uncommon anomaly of systemic venous drainage. We present a unique case of simultaneous presentation of cor triatriatum and persistent left superior vena cava draining into the left atrium in an adult female with partial AV canal and common atrium. Complex intra-atrial baffling including a procedure to redirect flow from a proximal atrial chamber was successful.
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He H, Li B, Ma Y, Zhang Y, Ye C, Mei C, Yu S, Dai B, 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; 20:202. [PMID: 31164092 PMCID: PMC6549367 DOI: 10.1186/s12882-019-1339-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/15/2019] [Indexed: 11/20/2022] Open
Abstract
Background Persistent left superior vena cava (PLSVC) is a common vena cava malformation, and drains blood into the right atrium via the dilated coronary sinus in most cases. It is usually asymptomatic and detected incidentally during invasive procedures or imaging. Whether the hemodialysis catheters can be placed in PLSVC is still controversial now (Stylianou et al. Hemodial Int 11:42-45, 2007). Case presentation Here we report a rare case of catheterization through PLSVC in an end-stage renal disease (ESRD) male patient whose PLSVC connected with pulmonary vein with insufficient blood flow eventually. Among the other 28 cases included in the literature review, 16 cases were non-tunneled catheter and 12 cases were cuffed, tunneled catheter and most of them could provide adequate blood flow. Conclusion PLSVC is a rare malformation and mostly asymptotic, we believe that PLSVC drains blood into the right atrium with enough inner diameter and blood flow can serve as an alternative site for conventional dialysis access. However, the feasibility of hemodialysis catheterization through it and measures to avoid serious complications are still needed to be discussed.
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Fujino T, Yuzawa H, Kinoshita T, Shinohara M, Okishige K, Ikeda T. A case of successful cryoballoon ablation of paroxysmal atrial fibrillation originating from a persistent left superior vena cava. J Cardiol Cases 2019; 20:77-80. [PMID: 31497169 DOI: 10.1016/j.jccase.2019.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/07/2019] [Accepted: 04/11/2019] [Indexed: 10/26/2022] Open
Abstract
We present a paroxysmal atrial fibrillation (AF) patient who had frequent AF events originating from a persistent left superior vena cava (PLSVC) with an unsuccessful catheter ablation using a non-irrigated radiofrequency catheter and was successfully cured by a successful PLSVC isolation using a second-generation cryoballoon catheter (28-mm, second-generation cryoballoon, Arctic Front Advance, Medtronic, Minneapolis, MN, USA). <Learning objective: This is the first case report illustrating a successful ablation of a persistent left superior vena cava in a patient with drug-resistant atrial fibrillation (AF) using a second-generation cryoballoon (CB) with a good outcome. By choosing an appropriate position and attaching the CB fixedly, the CB ablation was able to cure the AF smoothly without any complications including left phrenic nerve palsy or left coronary artery stenosis. An intracardiac electrocardiogram and 3-dimensional mapping system could detect conducted ectopic beats initiating AF.>.
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Li T, Xu Q, Liao HT, Asvestas D, Letsas KP, Li Y. Transvenous dual-chamber pacemaker implantation in patients with persistent left superior vena cava. BMC Cardiovasc Disord 2019; 19:100. [PMID: 31035937 PMCID: PMC6489345 DOI: 10.1186/s12872-019-1082-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent left superior vena cava (PLSVC) is a rare congenital vascular anomaly. Permanent pacemaker implantation (PPI) in patients with PLSVC can be challenging because of the venous anomalies. We reported a case series of patients with PLSVC who underwent PPI with double active fixation leads. METHODS From January 2012 to July 2016, 9 patients (three male and six females, mean age 68 ± 11 years) with PLSVC who received a dual-chamber pacemaker with double active fixation leads were enrolled retrospectively in this observational study. The indications for pacemaker implantation were symptomatic third-degree atrioventricular block in one and sick sinus syndrome in eight patients. RESULTS PPI were implanted successfully in all 9 patients. Successful positioning of the ventricular leads at the right ventricular outflow tract (RVOT) septum with a "C" shaped stylet was achieved in 7 patients (77.8%). In the remaining two cases, the ventricular leads were placed in the right ventricular apex and the inferior free wall of the sub-tricuspid annulus. The atrial leads were placed at the lateral wall of the right atrium in all patients. Procedure time and fluoroscopy time were 85.3 ± 11.3 min and 4.5 ± 1.1 min respectively. During a mean follow-up of 4 years, no complications were observed and pacing parameters did not change significantly. CONCLUSION PPI through PLSVC may be technically feasible, safe, and effective. Double active fixation leads may be standard for patients with PLSVC and most of the ventricular leads could be placed at the RVOT septum.
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Sinha SK, Goel A, Razi M, Jha MJ, Mishra V, Aggarwaal P, Thakur R, Krishna V, Pandey U, Varma CM. Permanent Pacemaker Implantation in Patients With Isolated Persistent Left Superior Vena Cava From a Right-Sided Approach: Technical Considerations and Follow-Up Outcome. Cardiol Res 2019; 10:18-23. [PMID: 30834055 PMCID: PMC6396803 DOI: 10.14740/cr784] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 01/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Positioning a permanent pacing wire in patients with persistent left superior vena cava (PLSVC) to right ventricle often comes as on-table surprise. It is technically demanding and therefore most of operators prefer left-sided approach. We assessed technical challenges during pacemaker implantation, and their short- and long-term outcomes among patients with isolated PLSVC from a right-sided approach. Methods Thirty-one consecutive patients with isolated PLSVC and 93 patients with right superior vena cava (RSVC) were enrolled with syncope with sinus node dysfunction (SND) and atrioventricular (AV) block. Study was designed on the basis of nested case-control method, and therefore 1:3 proportions was the enrolment criteria to detect any difference as statistically significant as incidence of isolated PLSVC is low. Results Mean age of patients was 64.8 ± 10.5 years. SND was the most common indication (n = 55; 44%) followed by AV block (n = 47; 37%). Nineteen (20%) patients received tined pacing lead, while 105 (85%) had screwing lead. There was no significant difference in mean procedural time (25 ± 11 min vs. 23 ± 12 min; P = 0.24), mean fluoroscopic time (3.1 ± 2.2 min vs. 2.7 ± 2.1 min; P = 0.54), pacing parameters for atrial and ventricular leads, dislodgement rate (3.2% vs. 4.8%; P = 0.32) and follow-up duration (6.9 ± 1.3 years vs. 7.2 ± 1.1 years; P = 0.18) between two groups. Compared to patients with RSVC, those with PLSVC had alpha loop configuration for ventricular lead which was statistically significant (31 vs. 00; P = 0.002). Conclusions Patients with PLSVC had alpha loop configuration for ventricular lead because of circuitous course via left mediastinum. Although pacemaker implantation through coronary sinus via isolated PLSVC from right sided-approach is technically challenging, it obtains good long-term results but needs frequent follow-up during the initial period.
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A rare variation of the hemiazygos vein draining into the persistent left superior vena cava. Anat Sci Int 2019; 94:269-273. [PMID: 30778907 DOI: 10.1007/s12565-019-00477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Abstract
During an educational dissection of a 72-year-old Chinese male cadaver, the hemiazygos vein (HAV) coursing the left side that drains into the persistent left superior vena cava was observed. The HAV was formed at the junction of the 9th to 11th right posterior intercostal veins, right subcostal vein, 5th to 11th left posterior intercostal veins, and left subcostal vein; it then ascended posteriorly to the thoracic aorta. After collecting the accessory hemiazygos vein, it crossed over the aorta and the pedicle of the left lung via the hemiazygos arch, then converged with a communicative branch (vein of Marshall) that emerged from the left brachiocephalic vein to form the persistent left superior vena cava and entered the pericardium at the level of the sixth thoracic vertebra. Upon opening the pericardium of our cadaver, the persistent left superior vena cava was found to drain directly into the significantly dilated coronary sinus at the level of the eighth thoracic vertebra. The azygos vein was formed by the union of the first to eighth right posterior intercostal veins and appeared to be finer and shorter than the HAV. The persistent left superior vena cava might be the result of incomplete degeneration of the left posterior cardinal vein. Knowledge of such variations could be of great value to surgeons placing peripherally inserted central catheters because incorrect placement of the azygos venous system can be detrimental to the patient. In addition, during heart surgery, awareness of such variations may prevent major complications, such as hemorrhage or damage to vascular structures, and possibly also provide new insights and perspectives to cardiovascular surgeries.
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Mrochek AG, Kabak SL, Haidzel IK, Melnichenko YM, Kalenchic TI. Coexistence an aberrant right subclavian artery with other congenital anomalies: case report and review of the literature. Surg Radiol Anat 2019; 41:963-967. [PMID: 30737539 DOI: 10.1007/s00276-019-02206-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/01/2019] [Indexed: 12/30/2022]
Abstract
Aberrant right subclavian artery is the most common aortic arch anomaly that frequently occurs in coexistence with other congenital cardiovascular anomalies. A 32-year-old male patient was hospitalized with ventricular septal defect, chronic heart failure NYHA class III, pulmonary arterial hypertension. Contrast-enhanced multislice computed tomography revealed membranous ventricular septal defect, persistent left superior vena cava, bicuspid aortic valve and aberrant right subclavian artery. Aberrant right subclavian artery was clinically silent and discovered accidentally. The patient underwent heart-lung transplantation due to pronounced, irreversible pulmonary hypertension. This article reports a rare coexistence of aberrant right subclavian artery with other congenital anomalies of the heart and great vessels in living men.
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Chokr MO, de Moura LG, Aiello VD, Bruzzamolino Teixeira KP, de Souza OF, Scanavacca MI. Atrioventricular nodal reentrant tachycardia and persistent left superior vena cava: A tough nut to crack. Successful ablation with transseptal approach. HeartRhythm Case Rep 2018; 4:589-593. [PMID: 30581739 PMCID: PMC6301891 DOI: 10.1016/j.hrcr.2018.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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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 2018; 67:723-725. [PMID: 30293219 DOI: 10.1007/s11748-018-1018-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/29/2018] [Indexed: 11/26/2022]
Abstract
Persistent left superior vena cava (PLSVC) is the most common anomalous thoracic venous drainage. A PLSVC usually drains into the right atrium through a dilated coronary sinus. It is rare that a PLSVC flows directly into the left atrium, and even rarer that it connects to the left upper pulmonary vein (LUPV). We report a case, wherein the LUPV connected to both the PLSVC and the left atrium.
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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; 18:234-236. [PMID: 30121329 PMCID: PMC6302776 DOI: 10.1016/j.ipej.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022] Open
Abstract
We report the case of an 84-year-old female with symptomatic bradycardia due to a complete atrioventricular block, who carried absent right and persistent left superior vena cava (SVC). Implantation of a pacing lead, particularly within the right ventricle (RV) in a patient with this venous anomaly is accompanied by technical difficulties. However, the apparatus consisting of a fixed-curve sheath (Model C315-S10, Medtronic, Inc., Minneapolis, MN, USA) and a lumenless fixed-screw pacing lead (Model 3830, Medtronic), allowed a rapid delivery into the RV without any complications. By rotating the Model C315-S10 sheath in the counterclockwise direction in the right atrium, its tip faced the tricuspid orifice, advanced across the tricuspid valve and confronted the RV lower septum near the apex. Then the RV-lead was fixed with acceptable pacing and sensing parameters. Utilizing a lumenless pacing lead and a preformed sheath to deliver it is a novel approach that could be helpful in pacemaker implantation in patients with absent right and persistent left SVC.
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Uhm JS, Choi JI, Baek YS, Yu HT, Yang PS, Kim YG, Oh SK, Park HS, Lee KN, Kim TH, Shim J, Joung B, Pak HN, Lee MH, Kim YH. Electrophysiological features and radiofrequency catheter ablation of supraventricular tachycardia in patients with persistent left superior vena cava. Heart Rhythm 2018; 15:1634-1641. [PMID: 29953955 DOI: 10.1016/j.hrthm.2018.06.034] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND The electrophysiological features and roles of persistent left superior vena cava (PLSVC) in supraventricular tachycardia (SVT) are not known. OBJECTIVE The purpose of this study was to elucidate the electrophysiological features and roles of PLSVC in patients with SVT. METHODS We included 37 patients with PLSVC (mean age 43.5 ± 17.1 years; 35.1% men) and 510 patients without PLSVC (mean age 43.9 ± 18.8 years; 48.2% men) who underwent an electrophysiology study for SVT. The number of induced tachycardias, location of the slow pathway (SP) or accessory pathway (AP), and radiofrequency catheter ablation (RFCA) outcomes were compared between patients with and without PLSVC. During RFCA of the left AP, a coronary sinus (CS) catheter was placed into the left superior vena cava (left superior vena cava group) or the great cardiac vein (great cardiac vein group). The RFCA outcomes were compared between the groups. RESULTS In patients with PLSVC, 40 tachycardias were induced: atrioventricular nodal reentrant tachycardia (AVNRT) (n = 19), atrioventricular reentrant tachycardia (n = 17), and focal atrial tachycardia (n = 4). Among patients with AVNRT, an SP in the CS was significantly more frequent in patients with PLSVC than in those without PLSVC (47.4% vs 3.8%; P < .001). In patients with the left AP, the number of RFCA attempts and recurrence were lower in the great cardiac vein group than in the left superior vena cava group. CONCLUSION An SP in the CS is prevalent in patients with AVNRT and PLSVC. It is useful to place a CS catheter into the great cardiac vein in patients with a left AP and PLSVC.
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