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. 2014 Oct 6;14(5):268-72.
doi: 10.1016/s0972-6292(16)30799-9. eCollection 2014 Sep.

Cardiac resynchronization therapy in a patient with persistent left superior vena cava draining into the coronary sinus and absent innominate vein: a case report and review of literature

Girish M Nair  1 , Seeger Shen  1 , Pablo B Nery  1 , Calum J Redpath  1 , David H Birnie  1
Affiliations

Cardiac resynchronization therapy in a patient with persistent left superior vena cava draining into the coronary sinus and absent innominate vein: a case report and review of literature

Girish M Nair et al. Indian Pacing Electrophysiol J. .

Abstract

Introduction: Persistent left superior vena cava (PLSVC) is a rare congenital anomaly of the superior venous system that may be discovered at the time of cardiac implantable electronic device (CIED) implantation.

Methods and results: We present a subject who needed cardiac resynchronization therapy (CRT)-CIED implantation and was discovered to have PLSVC with absent innominate vein during the implant procedure. We were able to successfully implant a CRT-CIED using a right-sided approach via the right superior vena cava (SVC). We present a description of our implant technique and a brief review of the different aspects of CIED implantation in subjects with variants of PLSVC.

Conclusion: Superior venous anomalies such as PLSVC can make CIED implantation technically challenging. However, with increasing operator experience, cardiac imaging and appropriate tools successful CIED implantation is possible in almost all cases.

Keywords: Absent Innominate Vein; Cardiac Resynchronization Therapy; Coronary Sinus; Persistent Left Superior Vena Cava.

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Figures

Figure 1
Figure 1
Panel A: Venogram showing the course of the right superior vena cava (SVC) draining into the right atrium Panel B: Venogram showing the left subclavian vein (SCV) draining into a persistent left superior vena cava (PLSVC). The venogram also demonstrates the absence of the innominate vein
Figure 2
Figure 2
Panel A: Image showing the course of a J-tip 0.032" hydrophilic guide wire through the persistent left superior vena cava (PLSVC) into the coronary sinus (CS). The acute angulation of the coronary guide wire at the confluence of the PLSVC and CS is shown. This anatomical feature may make cannulation and delivery of a CS pacing lead technically challenging Panel B: Venography using a CS sub-selector catheter, positioned at the confluence of the PLSVC with the CS, demonstrate the anatomy of the CS and the presence of a lateral CS tributary suitable for pacing lead placement
Figure 3
Figure 3
Panel A: Coronary sinus (CS) venogram performed after cannulation using a guide catheter introduced via the right superior vena cava (SVC). The tip of the guide catheter has been positioned distal to the confluence of the persistent left superior vena cava (PLSVC) and the CS. In view of the relative narrow caliber of the CS an occlusive venogram was not performed Panel B: Image showing a bipolar 6F endocardial pacing lead over a 0.014" coronary guide wire being introduced into the lateral CS tributary
Figure 4
Figure 4
Final position of pacing leads in the heart. RA- Right atrium; RV- Right Ventricle; CS- Coronary sinus
See this image and copyright information in PMC

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