Vascular anomaly – persistent left superior vena cava
Journal
Cardiologia Croatica
Date Issued
2013-09-23
Author(s)
Boshkov, Vladimir
Danilovska, Ilina
DOI
10.15836/ccar.2013.301
Abstract
Persistent left superior vena cava (PLSVC) is a very rare
congenital vascular anomaly, 0,3% in general population. In
90% of cases PLSVC flows into the right atrium via the coronary
sinus, but it can also be associated with other cardiovascular
abnormalities including ASD, VSD, bicuspid aortic
valve, coarctation of aorta and cor triatriatum, resulting in a
right to left sided shunt.
Our case, a 72-old male, was admitted to the hospital for a
third replacement of the pacemaker. We didn't have any
information for any vascular anomaly. The first indication for
implantation of a pacemaker — AAI, was dysfunction of sinoatrial
node. Few years later, there was progression of the
block and the patient was implanted a new system on the
other side, a dual-chamber pacemaker (DDDR). During the
second re-implantation, the patient was implanted a singlechamber
pacemaker (VVIR). Now we noticed malfunction of
the system and high impedance of electrode. X-ray before
procedure found lead fracture, hence it was decided to implant
a new system on the left side and the left subclavia
vein was used as a vascular access. Due to contrast application,
an aberrant flow was noticed, i.e. the left subclavia
vein drained into the right atrium via the coronary sinus, and
active fixation was used. Before each intervention we shall
review the complete patient documentation in detail and in
case we suspect any anomaly we shall carry out an echocardiography.
The dilatation of the coronary sinus would
indicate PLSVC.
congenital vascular anomaly, 0,3% in general population. In
90% of cases PLSVC flows into the right atrium via the coronary
sinus, but it can also be associated with other cardiovascular
abnormalities including ASD, VSD, bicuspid aortic
valve, coarctation of aorta and cor triatriatum, resulting in a
right to left sided shunt.
Our case, a 72-old male, was admitted to the hospital for a
third replacement of the pacemaker. We didn't have any
information for any vascular anomaly. The first indication for
implantation of a pacemaker — AAI, was dysfunction of sinoatrial
node. Few years later, there was progression of the
block and the patient was implanted a new system on the
other side, a dual-chamber pacemaker (DDDR). During the
second re-implantation, the patient was implanted a singlechamber
pacemaker (VVIR). Now we noticed malfunction of
the system and high impedance of electrode. X-ray before
procedure found lead fracture, hence it was decided to implant
a new system on the left side and the left subclavia
vein was used as a vascular access. Due to contrast application,
an aberrant flow was noticed, i.e. the left subclavia
vein drained into the right atrium via the coronary sinus, and
active fixation was used. Before each intervention we shall
review the complete patient documentation in detail and in
case we suspect any anomaly we shall carry out an echocardiography.
The dilatation of the coronary sinus would
indicate PLSVC.