Journal Information
Vol. 37. Issue 7.
Pages 627-628 (July 2018)
Vol. 37. Issue 7.
Pages 627-628 (July 2018)
Image in Cardiology
Open Access
Persistent left superior vena cava – A vascular access without limitations
Veia cava superior esquerda persistente – Um acesso vascular sem limitações
Visits
...
Tatiana Guimarães
Corresponding author
, Ana Bernardes, João de Sousa, Pedro Marques
Serviço de Cardiologia, Hospital de Santa Maria, Centro Académico Médico de Lisboa, CCUL, Lisboa, Portugal
Article information
Full Text
Download PDF
Statistics
Figures (1)
Additional material (1)
Full Text

Persistent left superior vena cava (PLSVC) is the most common thoracic congenital malformation and its diagnosis usually occurs by chance. Demonstrative clinical cases of dual-chamber (DDD) pacemaker implantation, implantable cardioverter defibrillators and cardiac resynchronization systems through PLSVC access have already been described in the literature. However, in most of the cases presented, the positioning of the lead in the right ventricle (RV) was restricted to the RV apex. To date, the literature reports only four cases of RV lead positioning in the right ventricular outflow tract (RVOT) via the PLSVC. The authors present the case of a 79-year-old female patient, diagnosed with syncope and left branch bundle block, in whom implantation of a DDD pacemaker was proposed. During the procedure, venous access was obtained via the left cephalic vein, and the lead was found to progress to the left of the spinal column, suggesting the presence of PLSVC. Through this access, it was possible to sequentially insert the RV lead in the RVOT and the atrial lead in the right atrial appendage, both with an active fixation system (Figure 1).

Figure 1.

Fluoroscopic image (right oblique projection) immediately after dual-chamber pacemaker implantation through the persistent left superior vena cava, with positioning of the ventricular lead in the right ventricular outflow tract (black arrow).

(0.11MB).

In conclusion, although PLSVC makes implantation of these types of cardiac devices difficult, it is not a limiting factor for the optimal positioning of the RV lead in the RVOT. Studies have shown that this placement is beneficial and is associated with less ventricular dyssynchrony, narrower QRS and higher cardiac output than apical right ventricular pacing.

Conflicts of interest

The authors have no conflicts of interest to declare.

Please cite this article as: Guimarães T, Bernardes A, de Sousa J, Marques P. Veia cava superior esquerda persistente – Um acesso vascular sem limitações. Rev Port Cardiol. 2018;37:627–628.

Copyright © 2018. Sociedade Portuguesa de Cardiologia
Idiomas
Revista Portuguesa de Cardiologia (English edition)

Subscribe to our newsletter

Article options
Tools
Supplemental materials
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email revista@spc.pt. I declare for all purposes that the information provided herein is accurate and correct.