Permanent Pacemaker Implantation in Patients with Persistent Left Superior Vena Cava

A world survey of 34 patients with persistent left superior vena cava who required permanent pacing is reviewed and one case of ours with dominant left superior vena cava is reported. Based on these cases, we conclude that the transvenous, rather than epicardial placement of a permanent pacemaker lead is the procedure of choice in patients with persistent left superior vena cava, with or without coexisting right superior vena cava.     

Superior vena cava syndrome due to a retained central venous pressure catheter.

A 70-year-old man had the superior vena cava syndrome. At thoracotomy a retained central venous pressure line was found to be the cause of venous thrombosis at the outlet of the superior vena cava into the right atrium. A retained central venous pressure catheter and catheter-induced venous thrombosis should be added to the list of causes of the benign form of the superior vena cava syndrome.     

Superior vena cava anomalies in the generation of angina pectoris: a report of two cases

Superior vena cava anomalies are rare occurrences caused by variations in the development of the embryonic venous system. Persistent left superior vena cavae are the most common congenital aberrations in the thoracic venous system, with an incidence of 0.3-0.5%, but their association in the absence of a right superior vena cava is extremely rare and scarcely reported. We report two case studies describing persistent left superior vena cavae found with and without a right superior vena cava in patients presenting with chest pain. A discussion regarding superior vena cava abnormalities as well as the etiology, associations, and diagnosis of these unusual entities follows.     

Obstruction of the superior vena cava caused by sclerosing mediastinitis. Surgical treatment by bypass with a composite spiral venous graft

A 68-year-old woman with obstruction of the superior vena cava due to sclerosing mediastinitis was successfully operated on. A composite spiral vein graft was interposed between the left innominate vein and the right atrium to bypass the occluded superior vena cava. The graft was made using the patient's own saphenous vein, which was divided longitudinally and sutured around a cannula in a spiral fashion. Indications to surgical intervention in patients with superior vena cava syndrome are discussed.     

Double superior vena cava with drainage of the right superior vena cava into the left auricle. Presentation as a cerebral abscess in an adult

A 44 year old man presented with a cerebral abscess, the location of which suggested a septicaemic origin. Although the patient was not cyanosed, a cardiological work-up was requested to exclude a right-to-left shunt. This showed a double abnormality of the systemic venous drainage: presence of an abnormal left superior vena cava draining into the coronary sinus and of a right superior vena cava draining into the left atrium. These two vena cava intercommunicated by anastomoses. Angiography in the right superior vena cava after occlusion by balloon catheter at its junction with the left atrium showed flow from the right to the left superior vena cava and to the azygos system. Simple ligature of the right superior vena cava was therefore performed to prevent recurrence of cerebral abscess. This case is rare and of interest because of the presence of two superior vena cavae, one on the right draining into the left atrium and the other on the left draining into the coronary sinus, with anastomoses between the two superior vena cavae. This double abnormality of systemic venous drainage explains the absence of cyanosis and therefore the relatively late detection of this malformation.     

Persistent left superior vena cava,absent right superior vena cava and coronary-bronchial fistula: The good,the bad and the ugly (case report and review of literature)

A 62-year-old Caucasian male presented with syncope during casual daily activity without preceding prodromes. During ECG Holter monitoring, we observed numerous asystolic pauses lasting >4 s due to sino-atrial blockade and sinus bradycardia. During pacemaker implantation, persistent left superior vena cava with agenesis of the right superior vena cava was diagnosed. Unproblematic placement of atrial lead was followed by challenging placement of the right ventricular lead. Anterior position with a sharp angulation to the right ventricular wall was achieved with excellent stimulation parameters. Transesophageal echocardiography confirmed the diagnosis of persistent left superior vena cava with agenesis of right superior vena cava. Moreover, selective coronary angiography showed connection between right coronary artery branch and bronchial vessel. To the best of our knowledge, we are the first to describe a combination of persistent left superior vena cava with absent right superior vena cava, coronary-bronchial fistula and conduction abnormality with the necessity of device implantation.     

Sinus node dysfunction associated with absence of right superior vena cava.

A 41-year-old man presented with dizziness associated with sinus bradycardia and sinus arrest. An attempt to implant a transvenous pacing lead was frustrated by absence of the right superior vena cava. The left superior vena cava persisted and drained via the coronary sinus into the right atrium. Absence of the right superior vena cava may present with symptomatic sinus node dysfunction and may require an epicardial demand pacing system.     

Two cases of left superior vena cava draining directly to a left atrium with a normal coronary sinus.

The most common variation in the thoracic systemic venous system is a persistent left superior vena cava draining to a coronary sinus. A rare anomaly is a persistent left superior vena cava connecting directly to the left atrium. In this situation it is believed that the coronary sinus must be absent. This report describes two cases of a persistent left superior vena cava draining to a left atrium with a normal coronary sinus.     

Sinus node dysfunction associated with absence of right superior vena cava.

A 41-year-old man presented with dizziness associated with sinus bradycardia and sinus arrest. An attempt to implant a transvenous pacing lead was frustrated by absence of the right superior vena cava. The left superior vena cava persisted and drained via the coronary sinus into the right atrium. Absence of the right superior vena cava may present with symptomatic sinus node dysfunction and may require an epicardial demand pacing system.     

Two cases of left superior vena cava draining directly to a left atrium with a normal coronary sinus

The most common variation in the thoracic systemic venous system is a persistent left superior vena cava draining to a coronary sinus. A rare anomaly is a persistent left superior vena cava connecting directly to the left atrium. In this situation it is believed that the coronary sinus must be absent. This report describes two cases of a persistent left superior vena cava draining to a left atrium with a normal coronary sinus.     

Cardiac lymphoma associated with superior vena caval syndrome and cardiac tamponade: case history

A sixty-three-year-old patient with malignant histiocytic lymphoma of the heart presented with both superior vena cava syndrome and cardiac tamponade. A two-dimensional echocardiogram showed a large tumor mass in the right atrium and pericardial effusion with right ventricular compression. Superior and inferior vena cavagrams disclosed a lobulated tumor located in the right atrium that extended into and obstructed the superior vena cava. After the pericardial effusion was drained and the diagnosis was established, the patient was irradiated and given chemotherapy with resolution of the tamponade and superior vena cava obstruction.     

Recurrent hepatocellular carcinoma presenting with superior vena cava syndrome

A 45-year-old male received wedge resection for his small hepatocellular carcinoma in April 1989 and extended right lobectomy for tumor recurrence 8 months later. Unfortunately, recurrent hepatic tumor with lung metastases were found 18 months after the second operation. Both the hepatic and pulmonary recurrent tumors were resected and transcatheter arterial embolization was added for the residual hepatic tumors. He remained symptom free for another 18 months. However, mediastinal lymphadenopathy, superior vena cava thrombus with superior vena cava syndrome, cardiac and brain metastases developed subsequently. He died of increased intracranial pressure. It is rare for hepatocellular carcinoma to have mediastinal metastases, superior vena cava thrombus and superior vena cava syndrome.     

Pitfalls in left atrial reduction. Superior neo-cava with pericardium

Left atrial reduction is a surgical technique that has been proposed for eliminating chronic atrial fibrillation associated with mitral valve disease. A potential complication of the technique is the unnoticed rotation of the heart while the left atrium is anastomosed. Such an event makes it impossible to reconstruct the superior vena cava, leading to superior vena cava syndrome due to the rotation of that vessel. We report our experience with a case of left atrial reduction and rotation of the superior vena cava while it was being anastomosed. The complication was successfully resolved by placing an autologous pericardial tube between the two ends of the superior vena cava.     

Superior vena cava syndrome as initial symptom of Vasculo-Beh?et's disease--case report]

A 26-year-old woman with a history of recurrent spontaneous abortion was admitted because of superior vena cava syndrome. Chest computed tomography and digital subtraction angiography revealed obstruction of the superior vena cava by a thrombus. After admission she also developed oral aphthous ulceration, erythema nodosum, and positive cutaneous hypersensitivity reaction to intradermal injection of saline. Laboratory investigations revealed HLA-B51 and positive lupus anticoagulant. We made the diagnosis of Vasculo-Beh?et's disease and treated her with heparin and urokinase with no clinical improvement. The fever subsided after prednisolone administration. Two years later, superior vena cava syndrome had slightly improved, although RI venography showed complete obstruction of the superior vena cava with development of collateral circulation. Endoscopic examination showed downhill esophageal varices. It is of note that the initial symptom in this case of Vasculo-Beh?et's disease was superior vena cava syndrome, and that lupus anticoagulant may have contributed to the thrombus formation.     

Relief of sleep apnea after intravascular stenting for superior vena cava syndrome.

A rarely reported association of sleep apnea and superior vena cava stenosis from mediastinal fibrosis is described. A case is presented where substantial improvement in the sleep parameters and the symptoms of sleep apnea occurred subsequent to superior vena cava thrombolysis and stent angioplasty.     

DDD pacemaker implantation in a patient with persistent left superior vena cava and absent right superior vena cava: a four-year follow-up report

Persistent left superior vena cava coexisting with the absence of right superior vena cava is an uncommon anomaly, and sometimes requires permanent pacemaker implantation due to the relatively high incidence of conduction disturbances and arrhythmias. This anomaly makes the implantation of pacemaker leads more difficult; therefore, accurate preintervention diagnosis of this anomaly is valuable for the interventionalist. A patient in which the diagnosis of persistent left superior vena cava coexisting with absent right superior vena cava was made echocardiographically before permanent pacemaker implantation is presented. Acetylsalicylic acid was prescribed after pacemaker implantation to prevent a potentially fatal complication of coronary sinus thrombosis, and no complication occurred during the four-year follow-up. Some clues for the noninvasive diagnosis of this anomaly and techniques of pacemaker implantation are also described briefly.     

Implantable cardioverter defibrillatory implantation in a patient with persistent left superior vena cava and right superior vena cava atresia

Persistence of a left superior vena cava has been observed in 0.3% of the general population as established by autopsy findings. In the adult population. it is an important anatomic finding if a left or right superior vena cava approach to the heart is considered for device implantation. We present a case with persistent left superior vena cava and right superior vena cava atresia in whom a dual chamber implantable cardioverter defibrillator was implanted and was technically challenging.     

Unusual venacaval anomalies in a patient with atrial septal defect

An unusual systemic venous drainage pattern was found in a 30-year-old man with ostium secundum atrial septal defect and pulmonary stenosis. He had the rare association of absent right superior vena cava, persistent left superior vena cava draining into the coronary sinus, and a left-sided inferior vena cava draining into a left superior vena cava through the hemiazygous vein.     

Endocardial pacing in a patient with sinus node dysfunction and absent right superior vena cava.

A patient with sinus node dysfunction and absent right superior vena cava underwent stable temporary and permanent endocardial pacing via a left sided superior vena cava. Active fixation of the electrode and epicardial pacing were not necessary.     

Endocardial pacing in a patient with sinus node dysfunction and absent right superior vena cava

A patient with sinus node dysfunction and absent right superior vena cava underwent stable temporary and permanent endocardial pacing via a left sided superior vena cava. Active fixation of the electrode and epicardial pacing were not necessary.