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Hata T, Kato K, Kamiya K, Okuyama Y, Fujii Y, Yagi N, Ozawa T, Nakagawa Y. Persistent Left Superior Vena Cava with the Absence of the Right Superior Vena Cava and Atrial Appendage: Complex Pacemaker Implantation in a Patient Presenting with a Rare Vascular Anomaly. Intern Med 2024; 63:1373-1376. [PMID: 37743512 PMCID: PMC11157321 DOI: 10.2169/internalmedicine.2391-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/08/2023] [Indexed: 09/26/2023] Open
Abstract
A persistent left superior vena cava (PLSVC) is a commonly observed anatomical anomaly that is frequently detected incidentally via computed tomography (CT) imaging. However, the occurrence of a PLSVC with a right superior vena cava (RSVC) defect, also known as "isolated PLSVC," is a much rarer anomaly. This peculiar malformation can lead to sinoatrial dysfunction, thus necessitating pacemaker implantation, which requires delicate manipulation due to various anatomical complexities. We herein present a case of a sick sinus syndrome with this rare anomaly, which required special consideration when performing pacemaker lead placement.
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Affiliation(s)
- Toshika Hata
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Koichi Kato
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Kenichi Kamiya
- Depatment of Cardiovascular Surgery, Shiga University of Medical Science, Japan
| | - Yusuke Okuyama
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Yusuke Fujii
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Noriaki Yagi
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Tomoya Ozawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
| | - Yoshihisa Nakagawa
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Japan
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Russell J, Koroma T, Conteh V, Coker J, Conteh S, Bharat K, Mahdi O. Persistent left superior vena cava in a 29-year-old lady with Ebstein's anomaly and complete heart block. A case report and literature review. Ann Med Surg (Lond) 2022; 78:103884. [PMID: 35734721 PMCID: PMC9207079 DOI: 10.1016/j.amsu.2022.103884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 05/26/2022] [Accepted: 05/29/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- J.B.W. Russell
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
- Corresponding author. Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone.
| | - T.R. Koroma
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - V. Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - J. Coker
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - S. Conteh
- Department of Internal Medicine, Faculty of Clinical Sciences, College of Medicine and Allied Health Sciences, University of Sierra Leone, Sierra Leone
- Department of Internal Medicine, Connaught Teaching Hospital, Ministry of Health and Sanitation, Freetown, Sierra Leone
| | - Kumar Bharat
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
| | - O.Z. Mahdi
- Department of Internal Medicine, Choithrams Memorial Hospital, Freetown, Sierra Leone
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Mikami T. Permanent pacemaker implantation in a patient with persistent left superior vena cava with an absent right superior vena cava: A case report. J Cardiol Cases 2021; 24:34-36. [PMID: 34257759 DOI: 10.1016/j.jccase.2020.11.024] [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: 09/09/2020] [Revised: 10/29/2020] [Accepted: 11/25/2020] [Indexed: 11/26/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a common congenital anomaly of the thoracic venous system. PLSVC affects 0.3-0.5% of the general population, with 0.09-0.13% having PLSVC with an absent right superior vena cava. A 92-year-old woman was transported to our hospital by ambulance because of syncopal attacks lasting a few seconds. Electrocardiography showed paroxysmal supraventricular tachycardia and sinus arrest for up to 10 s with syncope when the arrhythmia stopped. This occurred repeatedly, and a diagnosis of sick sinus syndrome was made. The patient was scheduled for dual-chamber permanent pacemaker implantation. She had isolated PLSVC, and pacing lead was inserted into the right atrium through the PLSVC from her left subclavian vein. The "J" pre-shaped stylet was used to introduce the lead via the tricuspid valve to the right ventricular outflow tract (RVOT) and placed in the septum of RVOT. Another lead was advanced into the right atrial appendage using the "J" pre-shaped stylet. After three years of implantation, fluoroscopy showed a stable position of pacing leads, and pacemaker interrogations showed no major changes in parameters. <Learning objective: Persistent left superior vena cava (PLSVC) is a common anomaly of the thoracic venous system. PLSVC is either isolated or associated with an absent right superior vena cava and a connection with the left atrium creating a shunt. In isolated PLSVC and PLSVC with an absent right superior vena cava, implantation of a permanent pacemaker is difficult but possible using conventional devices.>.
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Affiliation(s)
- Takeshi Mikami
- Saga-ken Medical Center Koseikan, 400 Nakahara Kase-matchi, Saga-shi, Saga-ken 840-8571, Japan
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Hara M, Ueno M, Tanaka K, Yokomizo M, Hiraki T. Sudden Cardiac Arrest During Induction of General Anesthesia in a Patient With Isolated Persistent Left Superior Vena Cava After the Maze Procedure. J Cardiothorac Vasc Anesth 2021; 36:713-716. [PMID: 33840613 DOI: 10.1053/j.jvca.2021.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Masato Hara
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan.
| | - Mayu Ueno
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Kazuyuki Tanaka
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Michiko Yokomizo
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
| | - Teruyuki Hiraki
- Department of Anesthesiology, Kurume University School of Medicine, Fukuoka, Japan
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Acherman RJ, Evans WN, Restrepo H. Prenatal Diagnosis of Absent Right Superior Vena Cava in Referrals for Fetal Echocardiography. JOURNAL OF FETAL MEDICINE 2021. [DOI: 10.1007/s40556-020-00279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Demșa I, Crișu D, Haba CMȘ, Ursaru AM, Afrăsânie VA, Costache II, Petriș AO, Tesloianu DN. Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava and Discrete Subaortic Stenosis Diagnosed in a Patient with Sick Sinus Syndrome: A Case Report and Brief Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10100847. [PMID: 33086768 PMCID: PMC7589949 DOI: 10.3390/diagnostics10100847] [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: 09/22/2020] [Revised: 10/17/2020] [Accepted: 10/18/2020] [Indexed: 01/20/2023] Open
Abstract
A persistent left superior vena cava (PLSVC) is the most frequent anomaly of the venous drainage system. While both a right and left superior vena cava (SVC) are usually present, a unique, left-sided SVC, also known as an isolated PLSVC, accounts for only 10–20% of cases. It is frequently associated with arrhythmias and other congenital cardiac anomalies. Though it is usually an asymptomatic condition, it may pose significant problems whenever central venous access is needed. We report a case of an isolated PLSVC that was diagnosed incidentally during pacemaker implantation for sinus node dysfunction. The venous anomaly was associated with subvalvular aortic stenosis determined by a subaortic membrane; this particular association of congenital cardiovascular anomalies is a rare finding, with only a few cases reported in the literature. We aim to highlight the clinical and practical implications of this condition, as well as to discuss the embryonic development and diagnostic methods of this congenital defect.
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Affiliation(s)
- Irina Demșa
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
| | - Daniela Crișu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Correspondence: ; Tel.: +40-745-264-550
| | - Cristian Mihai Ștefan Haba
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Department of Internal Medicine, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania
| | - Andreea Maria Ursaru
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
| | - Vlad-Adrian Afrăsânie
- Department of Medical Oncology, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania;
| | - Irina Iuliana Costache
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Department of Internal Medicine, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania
| | - Antoniu Octavian Petriș
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
- Department of Internal Medicine, “Grigore.T. Popa” University of Medicine and Pharmacy, str. Universitatii nr. 16, 700083 Iași, Romania
| | - Dan Nicolae Tesloianu
- Department of Cardiology, Emergency Clinical Hospital “Sf. Spiridon”, Bd. Independenței nr. 1, 700111 Iași, Romania; (I.D.); (C.M.Ș.H.); (A.M.U.); (I.I.C.); (A.O.P.); (D.N.T.)
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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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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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Affiliation(s)
- Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea
| | - Yong Soo Baek
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Sung Yang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea
| | - Hee-Soon Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea
| | - Kwang No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Medical Center, Seoul, Korea.
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Hernández-Madrid A, Paul T, Abrams D, Aziz PF, Blom NA, Chen J, Chessa M, Combes N, Dagres N, Diller G, Ernst S, Giamberti A, Hebe J, Janousek J, Kriebel T, Moltedo J, Moreno J, Peinado R, Pison L, Rosenthal E, Skinner JR, Zeppenfeld K, Sticherling C, Kautzner J, Wissner E, Sommer P, Gupta D, Szili-Torok T, Tateno S, Alfaro A, Budts W, Gallego P, Schwerzmann M, Milanesi O, Sarquella-Brugada G, Kornyei L, Sreeram N, Drago F, Dubin A. Arrhythmias in congenital heart disease: a position paper of the European Heart Rhythm Association (EHRA), Association for European Paediatric and Congenital Cardiology (AEPC), and the European Society of Cardiology (ESC) Working Group on Grown-up Congenital heart disease, endorsed by HRS, PACES, APHRS, and SOLAECE. Europace 2018; 20:1719-1753. [DOI: 10.1093/europace/eux380] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Antonio Hernández-Madrid
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Robert-Koch-Str. 40, Göttingen, Germany
| | - Dominic Abrams
- PACES (Pediatric and Congenital Electrophysiology Society) Representative, Department of Cardiology, Boston Childreńs Hospital, Boston, MA, USA
| | - Peter F Aziz
- HRS Representative, Pediatric Electrophysiology, Cleveland Clinic Children's, Cleveland, OH, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- Academical Medical Center, Amsterdam, The Netherlands
| | - Jian Chen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Massimo Chessa
- Pediatric and Adult Congenital Heart Centre-University Hospital, IRCCS Policlinico San Donato, Milan, Italy
| | - Nicolas Combes
- Arrhythmia Unit, Department of Pediatric and Adult Congenital Heart Disease, Clinique Pasteur, Toulouse, France
| | - Nikolaos Dagres
- Department of Electrophysiology, University Leipzig Heart Center, Leipzig, Germany
| | | | - Sabine Ernst
- Royal Brompton and Harefield Hospital, London, UK
| | - Alessandro Giamberti
- Congenital Cardiac Surgery Unit, Policlinico San Donato, University and Research Hospital, Milan, Italy
| | - Joachim Hebe
- Center for Electrophysiology at Heart Center Bremen, Bremen, Germany
| | - Jan Janousek
- 2nd Faculty of Medicine, Children's Heart Centre, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Thomas Kriebel
- Westpfalz-Klinikum Kaiserslautern, Children’s Hospital, Kaiserslautern, Germany
| | - Jose Moltedo
- SOLAECE Representative, Head Pediatric Electrophysiology, Section of Pediatric Cardiology Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina
| | - Javier Moreno
- Department of Cardiology, Arrhythmia Unit, Ramón y Cajal Hospital, Alcalá University, Carretera Colmenar Viejo, km 9, 100, Madrid, Spain
| | - Rafael Peinado
- Department of Cardiology, Arrhythmia Unit, Hospital la Paz, Madrid, Spain
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Eric Rosenthal
- Consultant Paediatric and Adult Congenital Cardiologist, Evelina London Children's Hospital, Guy's and St Thomas' Hospital Trust, London, UK
| | - Jonathan R Skinner
- APHRS Representative, Paediatric and Congenital Cardiac Services Starship Childreńs Hospital, Grafton, Auckland, New Zealand
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Joseph Kautzner
- Institute For Clinical and Experimental Medicine, Prague, Czech Republic
| | - Erik Wissner
- University of Illinois at Chicago, 840 S. Wood St., 905 S (MC715), Chicago, IL, USA
| | - Philipp Sommer
- Heart Center Leipzig, Struempellstr. 39, Leipzig, Germany
| | - Dhiraj Gupta
- Consultant Electrophysiologist Liverpool Heart and Chest Hospital, Honorary Senior Lecturer Imperial College London and University of Liverpool, Liverpool, UK
| | | | - Shigeru Tateno
- Chiba Cerebral and Cardiovascular Center, Tsurumai, Ichihara, Chiba, Japan
| | | | - Werner Budts
- UZ Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium
| | | | - Markus Schwerzmann
- INSELSPITAL, Universitätsspital Bern, Universitätsklinik für Kardiologie, Zentrum für angeborene Herzfehler ZAH, Bern, Switzerland
| | - Ornella Milanesi
- Department of Woman and Child's Health, University of Padua, Padua Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit, Department of Cardiology, Hospital Sant Joan de Déu, Barcelona - Universitat de Barcelona, Passeig Sant Joan de Déu, 2, Esplugues, Barcelona, Catalunya, Spain
| | - Laszlo Kornyei
- Gottsegen Gyorgy Orszagos Kardiologiai, Pediatric, Haller U. 29, Budapest, Hungary
| | - Narayanswami Sreeram
- Department of Pediatric Cardiology, University Hospital Of Cologne, Kerpenerstrasse 62, Cologne, Germany
| | - Fabrizio Drago
- IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, Roma
| | - Anne Dubin
- Division of Pediatric Cardiology, 750 Welch Rd, Suite 321, Palo Alto, CA, USA
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Isolated Persistent Left Superior Vena Cava, Sick Sinus Syndrome, and Challenging Pacemaker Implantation. Case Rep Cardiol 2017; 2017:9842524. [PMID: 28912977 PMCID: PMC5587925 DOI: 10.1155/2017/9842524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 07/27/2017] [Indexed: 11/17/2022] Open
Abstract
Persistent left superior vena cava with absent right superior vena cava is a very rare venous anomaly and is known as isolated PLSVC. It is usually an asymptomatic anomaly and is mostly detected during difficult central venous access or pacemaker implantation, though it could also be associated with an increased incidence of congenital heart disease, arrhythmias, and conduction disturbances. Herein, we describe a dual-chamber pacemaker implantation in a patient with isolated PLSVC and sick sinus syndrome.
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Zhang T, Wang J, Ming T, Shang LH. Pacemaker Implantation in a Patient with Paroxysmal Atrial Fibrillation and Persistent Left Superior Vena Cava with Absent Right Superior Vena Cava. Chin Med J (Engl) 2017; 130:2005-2006. [PMID: 28776559 PMCID: PMC5555141 DOI: 10.4103/0366-6999.211898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Tao Zhang
- Department of Cardiology, The First Hospital of Tsinghua University, Beijing 100016, China
| | - Jun Wang
- Department of Respiratory Medicine, Beijing Chest Hospital, Beijing 101149, China
| | - Tan Ming
- Department of Cardiology, The First Hospital of Tsinghua University, Beijing 100016, China
| | - Li-Hua Shang
- Department of Cardiology, The First Hospital of Tsinghua University, Beijing 100016, China
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Bisoyi S, Jagannathan U, Dash AK, Tripathy S, Mohapatra R, Pattnaik NK, Sahu S, Nayak D. Isolated persistent left superior vena cava: A case report and its clinical implications. Ann Card Anaesth 2017; 20:104-107. [PMID: 28074807 PMCID: PMC5290679 DOI: 10.4103/0971-9784.197847] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The venous anomaly of a persistent left superior vena cava (PLSVC) affects 0.3%-0.5% of the general population. PLSVC with absent right superior vena cava, also termed as "isolated PLSVC," is an extremely rare venous anomaly. Almost half of the patients with isolated PLSVC have cardiac anomalies in the form of atrial septal defect, endocardial cushion defects, or tetralogy of Fallot. Isolated PLSVC is usually innocuous. Its discovery, however, has important clinical implications. It can pose clinical difficulties with central venous access, cardiothoracic surgeries, and pacemaker implantation. When it drains to the left atrium, it may create a right to left shunt. In this case report, we present the incidental finding of isolated PLSVC in a patient who underwent aortic valve replacement. Awareness about this condition and its variations is important to avoid complications.
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Affiliation(s)
- Samarjit Bisoyi
- Department of Cardiac Anesthesiology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Usha Jagannathan
- Department of Cardiac Anesthesiology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Anjan Kumar Dash
- Department of Cardiac Anesthesiology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Sabyasachi Tripathy
- Department of Cardiac Anesthesiology, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Raghunath Mohapatra
- Department of Cardiothoracic and Vascular Surgery, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Naba Kumar Pattnaik
- Department of Cardiothoracic and Vascular Surgery, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Satyajit Sahu
- Department of Cardiothoracic and Vascular Surgery, Apollo Hospitals, Bhubaneswar, Odisha, India
| | - Debashish Nayak
- Department of Cardiothoracic and Vascular Surgery, Apollo Hospitals, Bhubaneswar, Odisha, India
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13
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Mackey CG, Dargin JM. Left-sided superior vena cava and venous hyperoxia masquerading as inadvertent carotid artery catheterization. J Emerg Med 2014; 47:e31-5. [PMID: 24930445 DOI: 10.1016/j.jemermed.2014.02.004] [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: 09/07/2013] [Revised: 12/30/2013] [Accepted: 02/09/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND A persistent left-sided superior vena cava (PLSVC) is a rare, often asymptomatic, venous anomaly that may be first diagnosed during central venous catheterization. During chest radiograph interpretation, a PLSVC can be confused with inadvertent arterial catheterization. CASE REPORT We describe the presentation of a 45-year-old man with end-stage liver disease who required central venous catheterization for treatment of septic shock. An aberrantly placed catheter noted on chest radiograph and an elevated central venous oxygen saturation gave the appearance of inadvertent carotid artery catheterization. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: A persistent left-sided superior vena cava can masquerade as an inadvertent cannulation of the carotid artery during central line placement. It is important for emergency physicians to be aware of this possibility when evaluating a chest radiograph with an aberrantly placed catheter. Venous hyperoxia may further complicate attempts to differentiate between arterial and venous catheterization in patients with septic shock. After confirmatory tests, the emergency physician should consider removal of the catheter due to potential complications.
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Affiliation(s)
- Caleb G Mackey
- Department of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
| | - James M Dargin
- Department of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts; Tufts University School of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts; Department of Emergency Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts
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14
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Chen CY, Chu YC, Chang WK, Chan KH, Chen PT. Diagnosis and insertion of Hickman catheter for a patient with persistent left superior vena cava. ACTA ACUST UNITED AC 2013; 51:44-8. [PMID: 23711607 DOI: 10.1016/j.aat.2013.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 09/12/2012] [Accepted: 09/17/2012] [Indexed: 11/17/2022]
Abstract
A vascular access with good function for drug delivery is the basis of chemotherapy. If there is any congenital or acquired vascular abnormality, procedurally related and late complications such as vessel rupture, malposition, and dysfunction of the catheter with ensuing thrombosis may occur, especially when it is undiagnosed or ignored. We describe a case of implantable central venous catheter (CVC) malposition and subsequent insertion of a Hickman catheter for stem cell transplantation after the diagnosis of persistent left superior vena cava (PLSVC) by radiologic image studies. The case is about a 60-year-old male who suffered from mantle cell lymphoma. He complained of discomfort when chemotherapeutic drugs were delivered through an implanted subcutaneous port system. Malposition of the CVC with aberrant path venous catheter, which led to its migration to the right internal jugular vein (RIJV) was noted on the chest X-ray. In addition, results of ultrasound imaging revealed total occlusion of the RIJV, and a subsequent three-dimensional (3D) computed tomography (CT) reconstruction image revealed a PLSVC with an atretic right SVC. Ultrasound-guided venous puncture of the left internal jugular vein and intraoperative fluoroscopy for confirming the correct guide-wire path were used for successful insertion of Hickman catheter without any complication. When unexpected occurrence of migration or malposition of the long-term CVC is detected, early removal of the catheter is vital for preventing further complications. Proper and advanced image studies including ultrasound, contrast-enhanced venography, CT, and magnetic resonance imaging may be necessary for understanding the potential vascular abnormality and guiding the following treatment.
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Affiliation(s)
- Chih-Yang Chen
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
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15
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Kuba PK, Sharma J, Sharma AK. Persistent Left Superior Vena Cava With Absent Right Superior Vena Cava and Bicuspid Aortic Valve: A Case Report and Review of Literature. Oman Med J 2013; 28:e049. [PMID: 31440357 PMCID: PMC6669301 DOI: 10.5001/omj.2013.65] [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] [Indexed: 11/03/2022] Open
Abstract
Persistent left superior vena cava with absent right superior vena cava is a rare congenital anomaly with few cases reported to date. To the best of our knowledge, the current case is the first one to be reported from New Zealand. The condition may present difficulties in central venous catheterization, pacemaker electrode insertion and cannulation during cardiopulmonary bypass. We describe a case of persistent left superior vena cava with absent right superior vena cava, who presented with aortic stenosis (bicuspid aortic valve) and rhythm disturbances.
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Affiliation(s)
- Paresh Kumar Kuba
- Cardiothoracic Surgery Division, Department of Surgery, Sultan Qaboos University Hospital, Muscat
| | - Jasvinder Sharma
- Formerly at Capital & Coast District Health Board, Wellington Public Hospital Wellington, New Zealand
| | - Ashok Kumar Sharma
- Formerly Director Wakefield Heart Centre and Clinical Leader Wellington Public Hospital, Wellington South, New Zealand
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16
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Gibelli G, Biasi S. Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava: Not Only an Anatomic Variant. J Cardiovasc Echogr 2013; 23:42-44. [PMID: 28465883 PMCID: PMC5353436 DOI: 10.4103/2211-4122.117985] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION A 71 year old asymptomatic woman came for an echocardiogram because of a left bundle branch block. A much dilated coronary sinus (CS) with an entering large vessel was found along with a mild left ventricular systolic dysfunction. Cardiac Magnetic Resonance (CMR) showed a persistent left superior vena cava (PLSVC), and an absent right superior vena cava (ARSVC). PLSVC drained into the dilated CS. No other cardiac abnormalities were found. Any late Gadolinium enhancement was also not seen. PLSVC and ARSVC are associated with sinus node and conduction tissue maldevelopment and atrial arrhythmias, and thus clinical follow up is indicated. CONCLUSION CMR is a useful addition to echocardiogram to search for further cardiac abnormalities, and outline the anatomy with precision in doubtful cases.
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Affiliation(s)
- Giuseppe Gibelli
- Department of Cardiology, S Carlo Clinic, Paderno Dugnano, Milano, Italy
| | - Salvatore Biasi
- Department of Cardiology, S Carlo Clinic, Paderno Dugnano, Milano, Italy
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17
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Wolf M, Scott B. Left-sided high-flow arteriovenous hemodialysis fistula combined with a persistent left superior vena cava causing coronary sinus dilatation. Semin Dial 2012; 26:E13-6. [PMID: 23237486 DOI: 10.1111/sdi.12047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present an interesting case illustrating the possible hemodynamic consequences when a left-sided arteriovenous hemodialysis fistula is combined with the congenital anomaly of a persistent left superior vena cava (PLSVC). Our case illustrates the importance of an echocardiographic examination with attention to the coronary sinus (CS) caliber-raising suspicion of a PLSVC-in the assessment for the hemodialysis access in end-stage renal disease patients. The causes and symptoms of CS dilatation, as well as the literature on PLSVC, are also discussed in detail.
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Affiliation(s)
- Michael Wolf
- Department of Cardiology, Antwerp Cardiovascular Institute Middelheim, Lindendreef 1, B-2020 Antwerp, Belgium.
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18
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Abstract
Isolated persistent left superior caval vein is a rare anomaly of the systemic venous return. We describe an unsuccessful pacemaker implantation through the right subclavian vein, which later turned out to be due to a venous anomaly. This case and some other cases show that with the help of a multidetector computed tomography, an isolated persistent left superior caval vein is not a contraindication for subclavian approached pacemaker insertion.
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19
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Lentini S, Recupero A. Recognition of persistent left superior vena cava in non-congenital patients undergoing cardiac surgery. Perfusion 2011; 26:347-50. [PMID: 21558302 DOI: 10.1177/0267659111408378] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Persistent left superior vena cava (PLSVC) represents the most frequent congenital malformation of the thoracic venous drainage system. In adults referred to surgery for an acquired cardiac disease, abnormal venous drainage may be missed if not carefully researched. Discovering a previously undiagnosed PLSVC during cardiopulmonary bypass (CPB) may present some inconvenience for both the perfusionist and the surgeon, especially during a minimally invasive approach. The authors believe PLSVC probably may represent an under-reported condition. A careful screening of patients undergoing cardiac surgery may prove helpful. In particular, a complete echocardiographic study may help to better diagnose this condition before surgery. Different signs may raise the suspicion of PLSVC and should be carefully researched during preoperative patient work-up.
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Affiliation(s)
- S Lentini
- Cardiovascular and Thoracic Department, Policlinico G. Martino Hospital, University of Messina, Viale Gazzi, Messina, Italy.
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20
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Jacob M, Sokoll A, Mannherz HG. A case of persistent left and absent right superior caval vein: An anatomical and embryological perspective. Clin Anat 2010; 23:277-86. [PMID: 20169608 DOI: 10.1002/ca.20945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The relatively common persistent left superior caval vein (LSCV) is in most cases associated with doubling of the superior caval vein. A persistent LSCV with absent right superior caval vein (RSCV)-a rather rare event-was found during our course of gross anatomy. The LSCV drained into an enlarged coronary sinus, which was partly accompanied by an apparent "double" sinus of normal size draining into this enlarged coronary sinus. Histological and immunofluorescence studies using antibodies against smooth and cardiac muscle actins were performed. The terminal part of the LSCV near the opening into the right atrium contained cardiac actin as expected for a normal derivative of the left sinus horn. Previously only one case of doubled coronary sinus with LSCV has been reported and this abnormality was explained by splitting of the sinus. In our case, the partly doubled coronary sinus had the structure of coronary veins. Mechanical forces have been invoked for the obliteration of the LSCV. Therefore, we examined thirteen human embryos from 15 mm to 32 mm crown-rump length. In one embryo, we found a persistent LSCV together with an enormously enlarged left atrium. Contrary to previous suggestions our data indicate that during normal development a compression of the left anterior cardinal vein does not sufficiently explain the obliteration of the left and the persistence of the right vein. We therefore believe that beside a left dominated blood flow of head and arm, genes for left-right signaling may have to be taken into consideration.
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Affiliation(s)
- Monika Jacob
- Department of Anatomy and Embryology, Ruhr University Bochum, Bochum, Germany
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21
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Xiong W, Shi C. Images in cardiovascular medicine: Concomitant persistent left superior vena cava and agenesis of right superior vena cava: a rare congenital anomaly. Circulation 2010; 121:2329-30. [PMID: 20516388 DOI: 10.1161/circulationaha.109.917336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Wei Xiong
- University of Arkansas for Medical Sciences, Little Rock, 72205-7199, USA.
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22
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Granata A, Andrulli S, Fiorini F, Logias F, Figuera M, Mignani R, Basile A, Fiore CE. Persistent left superior vena cava: what the interventional nephrologist needs to know. J Vasc Access 2009; 10:207-11. [PMID: 19670176 DOI: 10.1177/112972980901000313] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Variations in the course of the blood vessels are often incidental findings during clinical examination. Persistent left superior vena cava (PLSVC) is an uncommon anomaly, estimated to be present in about 0.3-0.5% of healthy individuals and in about 3-10% of patients with congenital heart disease. It results from the failure of the left anterior cardinal vein to degenerate during embryological development. Serious complications such as shock, angina and cardiac arrest have been described during catheterization in adults with a PLSVC. Since it frequently goes undiagnosed because of lack of symptoms when not accompanied by other anomalies, variations of the superior vena cava should be considered, especially when central venous catheterization via the subclavian or internal jugular vein is difficult. The embryological development, diagnosis, and clinical implications of a PLSVC are therefore reviewed in this article.
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Affiliation(s)
- Antonio Granata
- Departments of Nephrology & Dialysis, Internal Medicine & Radiology, Vittorio Emanuele-Ferrarotto-S. Bambino Hospital, University of Catania, Catania,Italy.
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23
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Ratnasamy C, Idriss SF, Carboni MP, Kanter RJ. Arrhythmias in children having a single left superior vena cava and minimal structural heart disease. J Cardiovasc Electrophysiol 2008; 20:182-6. [PMID: 18803560 DOI: 10.1111/j.1540-8167.2008.01307.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The presence of a single left superior vena cava in the absence of complex congenital heart disease is uncommon, and, in the absence of hemodynamic consequences, it would not be expected to result in cardiovascular signs or symptoms. Single case reports and our anecdotal experience suggested to us that this anomaly is highly associated with cardiac arrhythmias. OBJECTIVE We sought to describe the clinically important arrhythmias in a population of young patients having this anomaly. METHODS A retrospective chart review was performed from all patients <20 years old and who were determined by echocardiography over an 11-year-period to have a single left superior vena cava and minor or no coexisting congenital heart defects. The prevalence of nonsinus pacemaker, age-corrected sinus rate percentile, and prevalence of brady- or tachyarrhythmias was compared with a control group of patients having bilateral superior vena cavae. RESULTS Eight patients having a single left and 55 patients having bilateral superior vena cava(e) were identified. The existence of this anomaly tended to be associated with a lower age-corrected sinus rate percentile (17.5% vs 75%, P = 0.09), and was associated with a higher prevalence of arrhythmias (50% vs 7%, P = 0.014) compared with the control group. In the study group, one patient each had clinically relevant sinus node dysfunction, third-degree AV block, Wolff-Parkinson-White syndrome and atrial fibrillation, and AV nodal reentrant tachycardia. CONCLUSION Even in the absence of symptoms, patients found to have a single left superior vena cava should be monitored long-term for clinically important arrhythmias.
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Affiliation(s)
- Christopher Ratnasamy
- University of Miami School of Medicine, Jackson Memorial Hospital, Miami, Florida, USA
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24
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Recupero A, Pugliatti P, Rizzo F, Carerj S, Cavalli G, de Gregorio C, Di Bella G, Minutoli F, Arrigo F, Oreto G, Coglitore S. Persistent left-sided superior vena cava: integrated noninvasive diagnosis. Echocardiography 2008; 24:982-6. [PMID: 17894578 DOI: 10.1111/j.1540-8175.2007.00509.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Persistent left superior vena cava (PLSVC) is a rare finding. We describe 5 patients with PLSVC diagnosed by a noninvasive approach, including two-dimensional (2D) echocardiogram, nuclear magnetic resonance and multislice computed tomography (MCT). In 4 cases the PLSVC was isolated ("alone PLSVC"), and in 1 case associated with a right superior vena cava.
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Affiliation(s)
- Antonino Recupero
- Department of Medicine and Pharmacology, University Hospital, Via Consolare Valeria (Gazzi), 98125 Messina, Italy.
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25
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Wasse H. ASDM Clinical Case Focus: Persistent Left Superior Vena Cava: Diagnosis and Implications for the Interventional Nephrologist. Semin Dial 2006; 19:540-2. [PMID: 17150057 DOI: 10.1111/j.1525-139x.2006.00219.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Awareness and recognition of anatomic anomalies of the great vessels of the neck and chest are important for the interventional nephrologist, as central venous catheter placement is a common procedure. A persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly (0.3-0.5% of the population), and can present difficulty during internal jugular or subclavian vein catheter insertion, as well as pose a diagnostic dilemma. In this report, two cases of PLSVC are described, and the clinical significance and diagnosis of PLSVC are reviewed.
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MESH Headings
- Aged
- Angioplasty
- Catheterization, Central Venous/adverse effects
- Catheterization, Central Venous/instrumentation
- Female
- Graft Occlusion, Vascular/diagnosis
- Graft Occlusion, Vascular/diagnostic imaging
- Graft Occlusion, Vascular/etiology
- Graft Occlusion, Vascular/surgery
- Humans
- Kidney Failure, Chronic/therapy
- Middle Aged
- Nephrology
- Radiography
- Renal Dialysis/adverse effects
- Renal Dialysis/instrumentation
- Thrombectomy
- Vena Cava, Superior/abnormalities
- Vena Cava, Superior/diagnostic imaging
- Vena Cava, Superior/surgery
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Affiliation(s)
- Haimanot Wasse
- Renal Division, Department of Medicine, Emory University, Atlanta, Georgia 30322, USA.
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26
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Fang CC, Jao YTFN, Han SC, Wang SP. Persistent left superior vena cava: multi-slice CT images and report of a case. Int J Cardiol 2006; 121:112-4. [PMID: 17137647 DOI: 10.1016/j.ijcard.2006.08.099] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2006] [Accepted: 08/04/2006] [Indexed: 11/17/2022]
Abstract
Abnormalities of the vena cava system are usually asymptomatic and discovered incidentally during catheter placement or pacemaker implantation. Persistent left superior vena cava (PLSVC) is caused by failure of involution of the left anterior cardinal vein caudal to the left brachiocephalic vein during embryonic development. It is a benign condition, but becomes dangerous during pacemaker lead implantation, especially in emergency situations and when the right superior vena cava is absent. This is brought about by difficulty in pacemaker lead maneuvering into the right ventricle. A 64-cut multi-slice computed tomographic (MSCT) scan can show clear spatial relationship of the heart with its surrounding structures. We present a case of PLSVC discovered during pacemaker implantation, and viewed by 64-cut MSCT scan.
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27
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Ono-Yagi K, Nakagawa M, Okuno M, Shimada M. Absent right superior caval vein associated with partial trisomy 18. Hereditas 2001; 132:255-6. [PMID: 11075521 DOI: 10.1111/j.1601-5223.2000.t01-1-00255.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- K Ono-Yagi
- Department of Pediatrics, Shiga University of Medical Science, Japan.
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28
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Abstract
Heart rate monitoring has become a ubiquitous part of fetal and neonatal assessment, and has made detection of bradycardia in the fetal and neonatal periods a frequent occurrence. Evaluation of a fetus or neonate with bradycardia requires an understanding of the mechanisms of bradycardia as well as the cardiac and non-cardiac causes of bradycardia. The mechanisms of bradycardia include sinus bradycardia, abnormalities of sinus node function and abnormalities of atrioventricular conduction. In the instances where sinus bradycardia is pathologic, it usually results from non-cardiac disease. Sinus node dysfunction is rare early in life but can arise from surgical interventions, congenital heart disease, or endovascular manipulations. Abnormalities of atrioventricular conduction have a similar etiology but are more common than sinus node disease. Atrioventricular nodal disease can also result from maternal collagen vascular disease, even in the absence of symptoms in the mother. In these cases, epidemiological issues such as heart block in subsequent pregnancies and the maternal risk of developing symptomatic collagen vascular disease become important. The approach to treatment and long-term prognosis for bradycardia in the neonate is highly dependent on the underlying etiology and on the presence of concurrent factors such as structural heart disease.
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29
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Bartram U, Van Praagh S, Levine JC, Hines M, Bensky AS, Van Praagh R. Absent right superior vena cava in visceroatrial situs solitus. Am J Cardiol 1997; 80:175-83. [PMID: 9230155 DOI: 10.1016/s0002-9149(97)00314-7] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Absence of the right superior vena cava (SVC) in visceroatrial situs solitus is rare (0.07% to 0.13% of congenital cardiovascular malformations), and little is known about the type and frequency of additional heart defects and arrhythmias. We reviewed previous publications and present 9 new cases. Based on 121 known cases, we found that this anomaly is typically characterized by: (1) persistence of the left SVC draining into the right atrium by way of the coronary sinus, and (2) left-sided azygos vein draining into the left SVC. Less constant features were: (3) additional cardiovascular malformations (46%), and (4) rhythm abnormalities (36%) that usually appeared related to the complications of old age. Since absence of the right SVC is clinically silent, its status should be assessed echocardiographically prior to invasive medical or surgical procedures. This is important to avoid various management difficulties during the following procedures: (1) implantation of a transvenous pacemaker, (2) placement of a pulmonary artery catheter for intraoperative or intensive care unit monitoring without fluoroscopy, (3) systemic venous cannulation for extracorporeal membrane oxygenation, (4) systemic venous cannulation for cardiopulmonary bypass, (5) partial or total cavopulmonary anastomoses; and (6) orthotopic heart transplantation and endomyocardial biopsies.
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Affiliation(s)
- U Bartram
- Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA
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30
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Ho SY, Seo JW, Brown NA, Cook AC, Fagg NL, Anderson RH. Morphology of the sinus node in human and mouse hearts with isomerism of the atrial appendages. Heart 1995; 74:437-42. [PMID: 7488461 PMCID: PMC484053 DOI: 10.1136/hrt.74.4.437] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The location of the sinus node is known to be at best abnormal, or at worst unknown, in patients with isomerism of the morphologically left atrial appendage. In contrast, the sinus node is known to be an excellent histological marker of the morphologically right appendage, being duplicated in those with right isomerism. The aim of the study was to investigate this condition further in fetal human and mouse hearts. METHODS Serial histological sections of the area anticipated to contain the sinus node were studied in hearts with isomerism of the atrial appendages taken from 14 human fetuses and 13 iv/iv mice, using 12 mouse hearts with normally arranged or mirror imaged atrial chambers for controls. RESULTS All hearts with isomerism of the right appendages (two human and four mouse) had bilateral sinus nodes. The cases with isomerism of the left appendages (12 human and nine mouse) showed absence of a recognisable sinus node except in four cases (19%) in which a small remnant of the node was found. In three of these cases, it was related postero-inferiorly to the superior cavoatrial junction. CONCLUSIONS The concept of isomerism of the atrial appendages is endorsed by findings on the morphology of the sinus node, this being the most reliable histological criterion for existence of a morphologically right atrium. A small proportion of hearts with left isomerism had a structure resembling the sinus node, but it was hypoplastic and displaced postero-inferiorly, distant from its expected position had the hearts possessed an incompletely formed morphologically right appendage.
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Affiliation(s)
- S Y Ho
- Department of Paediatrics, National Heart and Lung Institute, London
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31
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Langford EJ, Sulke AN, Curry PV. Atrial permanent pacing for sinus node dysfunction with absent right superior vena cava. Int J Cardiol 1993; 40:177-8. [PMID: 8349382 DOI: 10.1016/0167-5273(93)90282-l] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In patients with sinus node dysfunction and normal atrioventricular conduction, single chamber atrial pacing (AAI or AAIR mode) represents the most physiological treatment. Sinus node dysfunction is recognised in association with an absent right superior vena cava, and we present a case in which complete resolution of symptoms was achieved with endocardial atrial permanent pacing.
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Affiliation(s)
- E J Langford
- Department of Cardiology, Guy's Hospital, London, UK
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32
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Bernardis C, Chatzis A, Treasure T. Absence of the right superior caval vein associated with disease of the sinus node. Int J Cardiol 1992; 36:115-7. [PMID: 1428243 DOI: 10.1016/0167-5273(92)90118-m] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Absence of the right superior caval vein has been shown by postmortem studies of infants and children to be associated with histological abnormalities of the sinus node. We report the case of a 32-yr-old man who presented with syncope due to disease of the sinus node and was found to have absence of the right superior caval vein. He was successfully managed with implantation of an epicardial atrioventricular sequential pacemaker.
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Affiliation(s)
- C Bernardis
- Regional Cardiothoracic Unit, St. George's Hospital, London, UK
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33
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Choudhry AK, Conacher ID, Hilton CJ, Roy RC, McGregor CG. Persistent left superior vena cava. JOURNAL OF CARDIOTHORACIC ANESTHESIA 1989; 3:616-9. [PMID: 2520944 DOI: 10.1016/0888-6296(89)90163-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- A K Choudhry
- Regional Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, United Kingdom
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34
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Abstract
Eight cases of absent right superior caval vein (vena cava) with normal atrial arrangement from the Great Ormond Street database were reviewed. In each case the right subclavian vein and jugular vein drained into a persistent left superior caval vein through a bridging vein. In six cases the left superior caval vein drained into the right atrium by way of the coronary sinus, and in two cases it drained into the left atrium directly because of the complete unroofing of the coronary sinus. The frontal plane P wave axis was displaced leftwards and upwards in four out of seven cases in which an electrocardiogram was available. No case showed arrhythmia on a standard electrocardiogram preoperatively. Echocardiograms were available in four cases and in each case diagnosis of the anomalous connections of the systemic vein was possible. Only one third of the cases showed a crescentic shadow of the persistent left superior caval vein on chest x ray. A chest x ray and electrocardiogram do not provide the means of reliable diagnosis of this condition, though they may suggest the possibility of its existence. Definitive diagnosis requires cross sectional echocardiography or angiocardiography or both.
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35
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Abstract
A patient who suffered from sinus node dysfunction and automatic atrial tachycardias underwent pacemaker implantation during which time a unilateral left superior vena cava was found. Despite the known difficulties in using this venous route, it was possible to place a transvenous endocardial screw-in lead in a stable position in the lower lateral wall of the right atrium.
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