Transvenous cardioverter-defibrillator implantation with a double coil lead via persistent left superior vena cava.

A dual-coil defibrillation lead was inserted in a 64-year-old male through a persistent left superior vena cava draining into the coronary sinus. The lead, connected to a cardioverter-defibrillator (ICD) implanted in the left pectoral area, was looped in the right atrium positioning the proximal and distal lead coils in the coronary sinus and right ventricular outflow track respectively and resulting in a low and stable defibrillation threshold. Because of its relative ease and effectiveness, this procedure may be recommended in patients with persistent left superior vena cava requiring an ICD implant.     

Persistent left superior vena cava in a man with ventricular fibrillation

A patient who had recurrent syncope and an episode of sudden cardiac arrest due to ventricular fibrillation unassociated with acute myocardial infarction is presented. An isolated left superior vena cava was discovered during electrophysiologic study. Ventricular fibrillation was readily induced by programmed ventricular stimulation in the initial (off the drugs) and subsequent serial electropharmacologic testings. These findings suggest that ventricular fibrillation may be the cause of sudden death in patients with this congenital abnormality.     

Permanent Pacing from a Left Ventricular Vein in a Patient with Persistent Left Superior Vena Cava and Absent Right Superior Vena Cava: Use of an Over-the-Wire System

In patients with a persistent left superior vena cava, placement of a permanent transvenous pacing lead for ventricular pacing via the left subclavian vein can be technically challenging. Permanent pacing was achieved in a patient with a persistent left superior vena cava and absent right superior vena cava using a left ventricular vein. Use of an over-the-wire lead system greatly facilitated this procedure.     

A rare association recognized before cardiac surgery: persistent left superior vena cava and secundum atrial septal defect

One of the most common congenital anomalies of systemic veins is persistent left superior vena cava. Association of persistent left superior vena cava with other congenital cardiac diseases is common and frequently encountered during diagnostic studies. Contrast echocardiography has an important role in the diagnosis. Owing to the fact that cardiopulmonary by-pass procedure may be problematic in patients with persistent left superior vena cava, this anomaly should be detected before cardiac surgery and required measures should be taken. Our case is an association of persistent left superior vena cava detected in a patient to be operated for secundum atrial septal defect. We report the case owing to its low frequency and to emphasize the importance of detection before cardiac surgery.     

Transvenous biventricular pacing for cardiac resynchronization therapy in patients with persistent left superior vena cava and right superior vena cava atresia

Biventricular pacing for cardiac resynchronization therapy is an effective adjunctive therapy for the treatment of symptomatic moderate and severe congestive heart failure. However, experience with transvenous cardiac resynchronization therapy in patients who have both persistent left superior vena cava and right superior vena cava atresia is extremely limited. We successfully performed cardiac resynchronization therapy in 2 patients who had persistent left superior vena cava, right superior vena cava atresia, and congestive heart failure. Our 2 cases demonstrate the possibility of a total transvenous approach for left ventricular pacing despite the presence of serious cardiac venous anomalies. This approach enables clinicians to avoid the riskier epicardial lead placement, which requires a thoracotomy under general anesthesia.     

Echocardiography of the coronary sinus in adults

The coronary sinus (CS) is a small tubular structure just above the posterior left atrioventricular junction. The CS can be imaged in several different echocardiographic views. Using zoom M-mode recordings of the CS in apical two-chamber view, CS caliber can be sharply imaged and easily measured during different phases of the cardiac cycle. We have recently shown that the CS narrows during atrial contraction in persons with sinus rhythm, but does not narrow at all if atrial fibrillation is present. Attenuation of CS narrowing occurs in patients with congestive heart failure and inferior vena cava plethora. Maximal CS caliber occurs during ventricular systole. Patients with poor left ventricular systolic function show mild CS dilatation. Greater CS dilatation is present in patients with persistent left superior vena cava, and huge dilatation when this anomaly is accompanied by absence of a right superior vena cava. Injection of sonicated saline into a left and then a right arm vein is diagnostically useful in confirming these two venous anomalies. Pulsed-wave Doppler of the CS can be recorded in the parasternal right heart inflow view. From this and from the CS cross-section area it may be possible to estimate coronary blood flow.     

Minimally invasive video-assisted thoracoscopic left ventricular epicardial lead implantation for biventricular pacing in a patient with persistent left superior vena cava

Cardiac resynchronization therapy (CRT) by biventricular pacing reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. Implantation of the biventricular pacing lead in association with persistent left superior vena cava is technically challenging. We report a successful case of minimally invasive video-assisted thoracoscopic left ventricular epicardial lead implantation for biventricular pacing in a patient with persistent left superior vena cava.     

Implantation eines Resynchronisationssystems bei persistierender oberer Hohlvene

We report an implantation of a cardiac re-synchronization system in a patient with persistent left superior vena cava. This anomaly occurs in 0.3 to 0.5% of healthy individuals and remains usually asymptomatic. Variations of the superior vena cava should be considered in venous catheterization and other procedures such as implantation of pacemaker and ICD systems as well as port catheter insertion. In re-synchronization systems, persistent left superior vena cava can be an obstacle for cannulation of the coronary sinus and placement of a transvenous left ventricular lead.     

Implantable cardiac defibrillator placement in a patient with persistent left superior vena cava and Brugada syndrome

A 45-year-old man was diagnosed with new-onset atrial fibrillation. Control of ventricular rate led to spontaneous conversion to sinus rhythm. Subsequent electrocardiograms revealed ST segment changes characteristic of Brugada syndrome. Electrophysiology study demonstrated inducible ventricular fibrillation. During the placement of an implantable cardiac defibrillator the patient was found to have a persistent left superior vena cava. Persistent left superior vena cava is present in 0.3% of cases in autopsy series. To date, persistent left superior vena cava has not been reported in association with Brugada syndrome. We report such a case.     

Persistent left superior vena cava: a blessing in disguise

Persistent left superior vena cava (SVC) is an uncommon condition,usually encountered during cannulation of the left subclavianvein. We describe a patient who required a cardiac device upgradeto cardiac resynchronization implantable cardioverter defibrillatorfor biventricular failure. The presence of a persistent leftSVC proved to be a blessing in disguise in this patient as hehad since developed total occlusion of the left subclavian-innominatesystem.     

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.     

Unroofed coronary sinus and persistent left superior vena cava.

This report describes a case of unroofed coronary sinus and persistent left superior vena cava discovered during an echocardiographic investigation for dilated pulmonary artery. An unroofed coronary sinus is a rare interatrial shunt that is commonly associated with a persistent left superior vena cava. The latter is a usual cause of a dilated coronary sinus. The detection of a dilated coronary sinus should therefore prompt the search for abnormal coronary sinus drainage and other cardiac abnormalities. The treatment of unroofed coronary sinus and persistent left superior vena cava is undertaken only after assessing the pre- and post-treatment haemodynamics of all co-existing abnormalities.     

Surgery of hepatoma with intracavitary cardiac extension

Summary A case of primary liver carcinoma with intracavitary cardiac extension is presented. A 36-year-old female was admitted to our surgical clinic with dyspnea and generalized edema. Echocardiography and superior vena cavography demonstrated a large filling defect in the right atrium. After a diagnosis of acute cardiac failure due to an intracardiac tumor, the patient was operated upon immediately. A right atriotomy exposed a large yellow mass within the right atrium, which was not adherent to the atrial wall. The mass was in continuity with similar material in the inferior vena cava and right hepatic vein. With a suspicion of hepatic malignancy, the atrial tumor was removed, and debulking of the mass in the inferior vena cava and right hepatic vein was performed. A postoperative histological examination of the tumor showed hepatocellular carcinoma. Her postoperative course was uneventful, and she was discharged from the hospital.Intracardiac extension of hepatoma is rarely encountered. In this clinical setting, long-term survival cannot be anticipated from any surgery, but palliative clearing of the atrium and inferior vena cava may be of value in preventing cardiac arrest causing sudden death.     

Reopening of a persistent left superior vena cava in the early postoperative period following bidirectional cavopulmonary anastomosis--treatment by coil embolization]

Diagnosis of systemic venous drainage is mandatory for patients with congenital heart disease planned for cavopulmonary anastomosis or any Fontan-type palliation. Preexisting venous channels as the persistent left superior vena cava are common in cardiac anomalies and may lead to postoperative deterioration and cyanosis. We describe a 6 month old boy with a complex imbalanced atrioventricular septal defect who developed cyanosis in the very early postoperative period, following bidirectional cavopulmonary anastomosis. It was caused by ineffective lung perfusion due to a reopened persistent left superior vena cava with drainage to the coronary sinus.He underwent coil embolization of the persistent left superior vena cava with retrievable coils and cyanosis improved. Coil embolization is an effective alternative to secondary surgery, especially for hemodynamically compromised patients in the postoperative period.     

An elusive persistent left superior vena cava draining into left atrium

A case report of a persistent left superior vena cava draining into left atrium with a fibromuscular left ventricular outflow tract obstruction and a small atrial septal defect. The anomalous vessel escaped detection during two right and left heart catheterizations from the right arm and open heart surgery. It was an incidental finding during cardiac catheterization from the left arm and the anatomy was confirmed by contrast echocardiography.     

Clinical diagnosis of persistent left superior vena cava by observation of jugular pulses

In seven patients with persistent left superior vena cava (LSVC) diagnosed at surgery or by intracardiac catheterization, the difference in amplitude between the left and the right jugular pulses was investigated. In sex cases the left jugular pulse had greater amplitude and in the seventh case the opposite was true, but this patient had “mirror-image” dextrocardia with situs inversus and therefore it was considered a positive sign. The greater amplitude of the jugular pulse in the same side of the anomalous superior vena cava (usually the left), appears to be a useful sign to suspect the diagnosis of this malformation.     

Left superior vena cava connection to unroofed coronary sinus associated with positional cyanosis: successful transcatheter treatment using Gianturco-Grifka vascular occlusion device.

A persistent left superior vena cava connection to an unroofed coronary sinus is a rare cardiac anomaly that is associated with a variable degree of cyanosis. We report an infant with this condition and the unusual feature of cyanosis dependent on head position. When the patient's head was rotated to the left, he developed severe stenosis of the left internal jugular vein, enlarged cervical collateral veins that connected to the right superior vena cava and had an oxygen saturation 95%. When the patient's head was rotated to the right, the left internal jugular vein was widely patent and systemic oxygen saturation decreased to 87%. There was no right ventricular volume overload. Temporary occlusion of the left superior vena cava documented tolerable proximal venous pressure. Cyanosis was relieved by transcatheter closure of the left superior vena cava with a Gianturco-Grifka vascular occlusion device. Cathet. Cardiovasc. Intervent. 48:369-373, 1999.     

Mitral valve prolapse causing severe mitral regurgitation in a patient with absent right pulmonary artery

A 33-year-old man was investigated for dyspnea on exertion and the presence of a pansystolic murmur. Physical examination revealed dextrocardia confirmed by chest radiograph, which also showed oligemic right lung field. Subsequent cardiac catheterization revealed secundum atrial septal defect, persistent left sided superior vena cava, and severe mitral valve prolapse causing severe mitral regurgitation with pulmonary hypertension. The right pulmonary artery was absent. It is the first report of the association between severe mitral valve prolapse and absent right pulmonary artery.     

Coronary Sinus Ostial Atresia and Persistent Left-Sided Superior Vena Cava: Clinical Significance and Strategies for Cardiac Resynchronization Therapy

A 48-year-old male patient underwent cardiac resynchronization therapy defibrillator implantation, and he was found to have atresia of the coronary sinus ostium with venous drainage occurring via a persistent left-sided superior vena cava, which was connected to the right-sided superior vena cava by the innominate vein. This is a rare benign cardiac anomaly that can pose problems when the coronary sinus needs to be cannulated. To identify the course of the coronary sinus, a coronary angiogram can be performed with attention directed to the venous phase of the angiogram. Although the technical difficulty of coronary sinus cannulation increases, various catheters, wires, and delivery systems can be utilized and this anomaly does not usually prevent successful left ventricular lead placement in cardiac resynchronization therapy via a left-sided superior vena cava approach. There however needs to be consideration regarding caliber of the left-sided superior vena cava being sufficiently large to avoid compromise of venous drainage after lead insertion.     

Coronary sinus ostial atresia with thrombus: a case report

An 82-year-old woman presented with mitral regurgitation and atrial fibrillation. She was hospitalized for further examination of cardiac thrombus detected by transthoracic echocardiography. No definitive diagnosis could be made based on computed tomography and magnetic resonance imaging. Intravenous contrast echocardiography suggested a coronary sinus thrombus. Coronary angiography showed coronary sinus ostial atresia. Multislice computed tomography confirmed the presence of thrombus in the enlarged coronary sinus with coronary sinus ostial atresia and persistent left superior vena cava. Persistent left superior vena cava is present in 3% of patients with congenital heart disease. Persistent left superior vena cava is detected by chance during cardiac catheterization for other conditions in patients without cardiac malformations. The present case was detected at an advanced age, and in the absence of prior symptoms.