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Bostan A, Astratinei DD, Tăbăcaru N, Ailoaei Ș, Stătescu C. Permanent pacemaker implantation in a challenging anatomy: Persistent left superior vena cava. Arch Clin Cases 2021; 7:34-39. [PMID: 34754925 PMCID: PMC8565685 DOI: 10.22551/2020.27.0702.10170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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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Affiliation(s)
- Alexandru Bostan
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi
| | | | - Narcis Tăbăcaru
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi
| | - Ștefan Ailoaei
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi
| | - Cristian Stătescu
- "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, Iasi.,"Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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van Schuppen J, van der Hulst AE, Kuipers IM, Straver B, Boekholdt SM, Planken RN, Oostra RJ. Midline crossing pulmonary vein: right upper lobe dual venous drainage, with partial anomalous venous return of the right lung into a persistent left superior vena cava. Surg Radiol Anat 2021; 44:99-103. [PMID: 34709422 PMCID: PMC8758614 DOI: 10.1007/s00276-021-02849-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
Introduction We present a case of dual drainage of the right upper lobe of the lung into the left atrium and via partial anomalous venous pulmonary return (PAPVR) into a persistent left superior vena cava (SVC). Discussion It is only in the minority of PAPVR cases where the anomalous pulmonary veins cross the midline. We provide a review of current literature on this topic and an explanatory embryological model. Knowledge of embryonic development and possible anatomic variations, including the concept of dual venous drainage of the lung, leads to better interpretation of imaging, with more accurate description of the morphology at hand. High-resolution multidetector computed tomography (MDCT) helps to delineate the exact vascular anatomy. This will enhance a better understanding of and anticipation on the patient’s disease status, with more accurate planning of intervention, and possibly less complications.
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Affiliation(s)
- J van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Suite C1-234, 1105 AZ, Amsterdam, The Netherlands.
| | - A E van der Hulst
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - I M Kuipers
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - B Straver
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - S M Boekholdt
- Department of Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Suite C1-234, 1105 AZ, Amsterdam, The Netherlands
| | - R J Oostra
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
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de Jesus M, Patel N, Cheema M, Weissler-Snir A. A rare cause of platypnea-orthodeoxia syndrome in a young female due to persistent left superior vena cava. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1790-1792. [PMID: 34156721 DOI: 10.1111/pace.14300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/28/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022]
Abstract
Platypnea-Orthodeoxia syndrome (POS) is a rare clinical syndrome characterized by shortness of breath in the upright position that is relieved with supine positioning. We present a rare case of persistent left superior vena cava (PLSVC) draining into the left atrium causing a right-to-left shunt and subsequent POS. A 30-year-old female with a past medical history of hypertrophic cardiomyopathy, congenital Long QT syndrome and a left-sided dual chamber implantable cardioverter-defibrillator (ICD) presented with dyspnea and lightheadedness. Prior to presentation, the patient underwent a left-sided ICD extraction due to ICD lead infection and re-implantation from the right side through the cephalic vein. After further investigation, it was concluded that the PLSVC resulted in a physiological right-to-left shunting causing POS, with resolution of her symptoms after surgical ligation. To our knowledge, this is the first case report of PLSVC presenting with POS without anatomical intracardiac shunts following iatrogenic right superior vena cava (RSVC) obstruction.
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Affiliation(s)
- Mikhail de Jesus
- Department of Medicine, University of Connecticut, Hartford, Connecticut, USA
| | - Nirav Patel
- Department of Cardiology, Hartford Hospital, Hartford, Connecticut, USA
| | - Mohiuddin Cheema
- Department of Cardiothoracic Surgery, Hartford Hospital, Hartford, Connecticut, USA
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Implantation of a Dual-Chamber Automatic Cardioverter Defibrillator in a Patient with Persistent Left Superior Vena Cava: Case Report and Brief Literature Review. Diagnostics (Basel) 2020; 10:diagnostics10121071. [PMID: 33322042 PMCID: PMC7763180 DOI: 10.3390/diagnostics10121071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/04/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022] Open
Abstract
Persistence of the left superior vena cava (PLSVC) is a congenital anomaly reported in 0.3–0.5% of patients. Due to the multiple and complex anatomical variations, transvenous lead placement can become challenging. We report the case of a 47-year-old patient diagnosed with non-ischemic dilated cardiomyopathy with reduced left ventricular ejection fraction (LVEF—27%), who was referred to our clinic for implantation of a dual-chamber cardioverter defibrillator for primary prevention of sudden cardiac death. During the procedure we encountered an abnormal guidewire trajectory and after venographic examination we established the diagnosis of persistent left superior vena cava. After difficult implantation of a 7F defibrillation lead through the coronary sinus, we managed to place the atrial lead through a narrow brachiocephalic vein into the right atrial appendage. In this paper, we aim to illustrate the medical and technical implications of implanting a cardioverter defibrillator in patients with PLSVC, highlighting the benefit of identifying and utilizing both the innominate vein, and the left superior vena cava and coronary sinus for placement of multiple leads, which would otherwise have been impossible.
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Lodhi HA, Morcos R, Bansal P, Mathews A, Al Taii H, Maini B, Khalili H. Transcatheter Closure of Persistent Left Superior Vena Cava Draining to Pulmonary Vein: A Rare Entity. JACC Case Rep 2020; 2:1120-1123. [PMID: 34317430 PMCID: PMC8311953 DOI: 10.1016/j.jaccas.2020.05.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 06/13/2023]
Abstract
We describe a patient with recurrent embolic strokes who was found to have a persistent left superior vena cava draining into a pulmonary vein. Transcatheter placement of a vascular plug resulted in successful occlusion of the superior vena cava. Repeat bubble study on follow-up imaging was negative for a right-to-left shunt. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Hamza A. Lodhi
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, Florida
| | - Ramez Morcos
- Department of Internal Medicine, Florida Atlantic University, Boca Raton, Florida
| | - Priya Bansal
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, Florida
| | - Adithya Mathews
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, Florida
| | - Haider Al Taii
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, Florida
| | - Brijeshwar Maini
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, Florida
- Tenet Healthcare Corporation, Boca Raton, Florida
| | - Houman Khalili
- Department of Cardiovascular Diseases, Florida Atlantic University, Boca Raton, Florida
- Tenet Healthcare Corporation, Boca Raton, Florida
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Milam AJ, Tou E, Lam P, Wachsman AM, Gereboff A. Persistent left superior vena cava with partial anomalous venous return in a liver transplant patient. Anaesth Rep 2020; 8:107-110. [DOI: 10.1002/anr3.12062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 11/06/2022] Open
Affiliation(s)
- A. J. Milam
- Department of Anaesthesiology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - E. Tou
- Department of Anaesthesiology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - P. Lam
- Department of Anaesthesiology Cedars‐Sinai Medical Center Los Angeles CA USA
| | - A. M. Wachsman
- Department of Radiology Cedars‐Sinai Medical Center Los AngelesCA USA
| | - A. Gereboff
- Department of Anaesthesiology Cedars‐Sinai Medical Center Los Angeles CA USA
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Sinha M, Pandey NN, Sharma A. Total anomalous pulmonary venous drainage to persistent left superior vena cava: a unique configuration. BMJ Case Rep 2019; 12:12/9/e231898. [PMID: 31540928 DOI: 10.1136/bcr-2019-231898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Mumun Sinha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj N Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Arun Sharma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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