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Image in Cardiology
Implantation of a cardiac resynchronization therapy defibrillator through a persistent left superior vena cava
Implantação de CRT-D através de veia cava superior esquerda persistente
Miguel Nobre Menezes
Corresponding author
mnmenezes.gm@gmail.com

Corresponding author.
, Ana Bernardes, João de Sousa, Pedro Marques
Serviço de Cardiologia, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, EPE, Lisboa, Portugal
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    "titulo" => "Implantation of a cardiac resynchronization therapy defibrillator through a persistent left superior vena cava"
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        "titulo" => "Implanta&#231;&#227;o de CRT-D atrav&#233;s de veia cava superior esquerda persistente"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0010" class="elsevierStylePara elsevierViewall">Persistence of the left superior vena cava is rare&#44; being found in 0&#46;3&#8211;2&#37; of the general population&#44; and shows considerable anatomical variability&#46; We report the case of a 64-year-old man with idiopathic dilated cardiomyopathy&#44; admitted electively for implantation of a cardiac resynchronization therapy defibrillator&#46; Access was achieved via the left cephalic vein&#44; but the lead was seen to advance to the left of the spinal column&#46; Contrast injection revealed a persistent left superior vena cava draining into the right atrium close to the coronary sinus ostium&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">On encountering this congenital defect&#44; many operators immediately decide to use special techniques&#44; particularly for biventricular devices&#59; some adopt a right approach to facilitate catheter manipulation&#44; others use a hybrid technique &#40;right and left in the same procedure&#41;&#44; and some implant the right ventricular lead in the left ventricle&#46; However&#44; these techniques can be rather complex and carry an increased risk of infection and vascular injury&#44; especially with a bilateral approach&#46; Therefore&#44; since according to various authors and our own experience conventional implantation can be safe and effective&#44; it was decided to attempt this approach first&#46; All the leads were positioned by the conventional technique&#44; including a quadripolar lead in the coronary sinus &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">At three-month follow-up stimulation thresholds were satisfactory and effective resynchronization had been achieved&#46; In conclusion&#44; although persistence of the left superior vena cava hampers implantation&#44; the simplest approach should be attempted first&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this investigation&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appears in this article&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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Revista Portuguesa de Cardiologia (English edition)
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