Implantation of VVI pacemaker in a patient with dextrocardia, persistent left superior vena cava, and sick sinus syndrome: A case report

Abstract

Background: Dextrocardia, or right-lying heart, is an uncommon congenital heart disease in which the apex of the heart is located on the right side of chest. Persistent left superior vena cava (PLSVA) is a rare venous anomaly that is often associated with the abnormalities of cardiac transduction system. A case with combination of dextrocardia, persistent left superior vena cava, and sick sinus syndrome has not been reported.

Methods: We used different techniques including cardiac color Doppler echocardiography, 24-hour Holter monitoring, and abdominal ultrasound to make a diagnosis and treated the patient by implanting a VVI pacemaker.

Results: A 50-year-old woman was admitted with a syncope. Angiography of the right atrium and superior vena cava, echocardiography, electrocardiography, and abdominal ultrasound revealed the presence of the combination of mirror image dextrocardia, PLSVA, and sick sinus syndrome. The complex structural anomalies presented great technical challenges for interventional treatments. After thorough examination and understanding of the structural anatomy and anomalies of the superior and inferior vena cava and cardiac chambers, we successfully treated this patient by implanting a VVI pacemaker.

Conclusion: Physicians must be aware of the complexity of the morphological and anatomical structures of dextrocardia accompanying PLSVC. Given that the diagnosis of situs inversus was performed at a relatively advanced age, it is therefore important to make such a correct diagnosis followed by appropriate therapeutic intervention.

Figure 1

Angiography of the inferior vena cava revealed the malformation of inferior vena cava: inverted U-shape of inferior vena cava draining into the right atrium from the upper portion of the heart.

Figure 2

Right atrial angiography revealed the entrance of the catheter from the malformed inferior vena cava into the right atrium.

Figure 3

Angiographic image of the right ventricle. An inferior vena cava (IVC) catheter ran through the malformed inferior vena cava, right atrium, and tricuspid valve and entered the right ventricle.

Figure 4

Angiographic image of the right superior vena cava. An inferior vena cava (IVC) catheter ran through the malformed inferior vena cava and right atrium and entered the right superior vena cava.

Figure 5

Image of the left superior vena cava obtained from atrial angiography performed via the left subclavian vein.

Figure 6

Angiographic image showing the drainage of the left superior vena cava into the right atrium.

Figure 7

Chest X-ray demonstrating the correct placement of the VVI pacemaker.