Acta Cardiologica
ISSN: 0001-5385 (Print) 0373-7934 (Online) Journal homepage: http://www.tandfonline.com/loi/tacd20
Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava Christophe Garweg, David Derthoo & Rik Willems To cite this article: Christophe Garweg, David Derthoo & Rik Willems (2014) Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava, Acta Cardiologica, 69:2, 220-221, DOI: 10.1080/AC.69.2.3017311 To link to this article: https://doi.org/10.1080/AC.69.2.3017311
Published online: 23 May 2017.
Submit your article to this journal
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=tacd20
220
Acta Cardiol 2014; 69(2): 220-221
doi: 10.2143/AC.69.2.3017311
Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava Christophe GARWEG1, MD; David DERTHOO1, MD; Rik WILLEMS, MD, PhD1,2 1
Dept. of Cardiology, University Hospitals Leuven, Leuven, Belgium; 2Dept. of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Keywords Persistent left superior vena cava – dual-chamber pacemaker.
We report a case of persistent left superior vena cava with persistent connection to the right superior vena cava discovered incidentally during the implantation of a dual-chamber pacemaker.
CASE PRESENTATION An 87-year-old woman was admitted to the emergency room for syncope. Her initial 12-lead ECG revealed third-degree heart block. Medical therapy consisted of ramipril 5 mg once daily for arterial hypertension. The patient underwent implantation of a dualchamber permanent pacemaker. Under local anaesthesia an incision was made in the left deltopectoral groove and the left cephalic vein was dissected. An additional puncture of the left subclavian vein was performed without difficulties. The ventricular lead (Medtronic Capsurefix Novus 5076-58) which was positioned
Address for correspondence: Prof. dr. Rik Willems, Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium, E-mail: [email protected] Received 18 July 2013; accepted for publication 25 July 2013.
through the cephalic vein passed fluently down the right side of the cardiac border in the right atrium, but the guidewire, used to position the sheath for the second lead, passed vertically down the left side of the cardiac border suggesting a persistent left superior vena cava (PLSVC) (figure A). It was impossible to reposition the guidewire in the right superior vena cava (RSVC) even with the use of a slippery guide wire (Terumo radifocus® guide wire M Standard type, diameter 0.46 mm). A venogram was performed and confirmed the diagnosis a PLSVC with a narrow connection to the right SVC (figure B). Subsequently, the atrial pacemaker lead (Medtronic Capsurefix Novus 407652) was positioned in the right atrium via the PLSVC. The ventricular lead had a “normal” projection (figure C, D and E).
CONFLICT OF INTEREST: none.
Pacemaker implantation and left superior vena cava
Fig. 1 (A) Course of the ventricular lead and of a guidewire after puncture of the left subclavian vein. (B) Contrast venogram from the right and left upper arm showed no connection between RSVC and PLSVC because of the presence of the ventricular lead within the brachiocephalic vein. (C) Position of the atrial and ventricular lead at the end of the implantation. (D) Antero-posterior radiographic view after lead placement. Atrial lead was positioned in the right atrium via the PLSVC. The ventricular lead has a “normal” projection through the RSVC. (E) Lateral radiographic view after lead placement. Atrial lead has an unusual course via the PLSVC.
221
ISSN: 0001-5385 (Print) 0373-7934 (Online) Journal homepage: http://www.tandfonline.com/loi/tacd20
Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava Christophe Garweg, David Derthoo & Rik Willems To cite this article: Christophe Garweg, David Derthoo & Rik Willems (2014) Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava, Acta Cardiologica, 69:2, 220-221, DOI: 10.1080/AC.69.2.3017311 To link to this article: https://doi.org/10.1080/AC.69.2.3017311
Published online: 23 May 2017.
Submit your article to this journal
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=tacd20
220
Acta Cardiol 2014; 69(2): 220-221
doi: 10.2143/AC.69.2.3017311
Dual-chamber pacemaker implantation through a persistent left superior vena cava with remaining connection to the right superior vena cava Christophe GARWEG1, MD; David DERTHOO1, MD; Rik WILLEMS, MD, PhD1,2 1
Dept. of Cardiology, University Hospitals Leuven, Leuven, Belgium; 2Dept. of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.
Keywords Persistent left superior vena cava – dual-chamber pacemaker.
We report a case of persistent left superior vena cava with persistent connection to the right superior vena cava discovered incidentally during the implantation of a dual-chamber pacemaker.
CASE PRESENTATION An 87-year-old woman was admitted to the emergency room for syncope. Her initial 12-lead ECG revealed third-degree heart block. Medical therapy consisted of ramipril 5 mg once daily for arterial hypertension. The patient underwent implantation of a dualchamber permanent pacemaker. Under local anaesthesia an incision was made in the left deltopectoral groove and the left cephalic vein was dissected. An additional puncture of the left subclavian vein was performed without difficulties. The ventricular lead (Medtronic Capsurefix Novus 5076-58) which was positioned
Address for correspondence: Prof. dr. Rik Willems, Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium, E-mail: [email protected] Received 18 July 2013; accepted for publication 25 July 2013.
through the cephalic vein passed fluently down the right side of the cardiac border in the right atrium, but the guidewire, used to position the sheath for the second lead, passed vertically down the left side of the cardiac border suggesting a persistent left superior vena cava (PLSVC) (figure A). It was impossible to reposition the guidewire in the right superior vena cava (RSVC) even with the use of a slippery guide wire (Terumo radifocus® guide wire M Standard type, diameter 0.46 mm). A venogram was performed and confirmed the diagnosis a PLSVC with a narrow connection to the right SVC (figure B). Subsequently, the atrial pacemaker lead (Medtronic Capsurefix Novus 407652) was positioned in the right atrium via the PLSVC. The ventricular lead had a “normal” projection (figure C, D and E).
CONFLICT OF INTEREST: none.
Pacemaker implantation and left superior vena cava
Fig. 1 (A) Course of the ventricular lead and of a guidewire after puncture of the left subclavian vein. (B) Contrast venogram from the right and left upper arm showed no connection between RSVC and PLSVC because of the presence of the ventricular lead within the brachiocephalic vein. (C) Position of the atrial and ventricular lead at the end of the implantation. (D) Antero-posterior radiographic view after lead placement. Atrial lead was positioned in the right atrium via the PLSVC. The ventricular lead has a “normal” projection through the RSVC. (E) Lateral radiographic view after lead placement. Atrial lead has an unusual course via the PLSVC.
221
