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      "titulo" => "An unthinkable cause of syncope"
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            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Axial thoracic computed tomography showing a giant cyst &#40;&#42;&#41; compressing the right heart&#46; &#40;B&#41; Four-chamber view&#44; balanced turbo field-echo &#40;BTFE&#41; cardiovascular magnetic resonance &#40;CMR&#41; showing a giant cyst &#40;&#42;&#41; compressing the right heart&#46; &#40;C&#41; Left ventricular tract outflow &#40;LVOT&#41; view&#44; BTFE CMR showing a giant cyst &#40;&#42;&#41; compressing the right atrium &#40;black arrow&#41;&#46; &#40;D&#41; BTFE CMR sagittal view of the cyst extension&#46; &#40;E&#41; Coronal thoracic computed tomography after the cyst resection&#46; &#40;F&#41; BTFE CMR showing the LVOT view after the cyst resection&#46;</p>"
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    "titulo" => "Placement of permanent pacemaker in a patient with venous anomaly through the right subclavian vein"
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#46; Venogram from the right upper limb showing the absence of a right SVC with the persistent left superior vena cava draining into the dilated coronary sinus&#46; B&#46; Chest X-ray demonstrating the loop configuration of the ventricular lead of the VVIR pacemaker&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 58-year-old female patient was admitted to our hospital with dizziness and near syncope&#46; The diagnosis of Mobitz type 2 atrioventricular block was made on electrocardiogram&#46; A dual-chamber pacemaker was inserted through the right side as the patient actively used her left arm&#46; The right ventricular &#40;RV&#41; lead was advanced in an attempt to access the right superior vena cava &#40;SVC&#41;&#44; but resistance was encountered&#46; Venography revealed persistent left superior vena cava &#40;PLSVC&#41; draining through the dilated coronary sinus &#40;CS&#41; into the right atrium with absent right SVC &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A&#41;&#46; Then&#44; a classic lead delivery system was used to reach the right atrium through CS and then through the tricuspid valve into the right ventricle&#46; The RV lead was advanced via PLSVC through the CS and was actively fixed to the right ventricle apex with loop configuration&#46; Following RV lead placement&#44; an atrial active fixation lead was introduced&#44; however we were unable to implant a pacemaker lead in a proper location&#46; The parameters of the implanted VVIR pacemaker were ventricular sensing of 6 mV&#44; pacing threshold of 0&#46;4 V&#44; and impedance of 630 ohms&#46; Chest X-ray revealed satisfactory positioning of the ventricular lead &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">While implanting cardiac devices in patients with PLSVC and absent right SVC&#44; it is difficult to pass through the tricuspid valve to place the ventricular lead&#46; Although lead implantation is very challenging due to abnormal vena cava anatomy&#44; different techniques can be used to facilitate the crossing tricuspid valve&#46; Physicians should be aware of the use of active fixation leads&#44; and conforming the loop configuration of the ventricular lead may overcome this technical challenge&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interests</span><p id="par0015" class="elsevierStylePara elsevierViewall">No potential conflict of interest was reported by the author&#40;s&#41;&#46;</p></span></span>"
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