Sabzwari SRA, Kimber J, Godil SA, Khan W, Mir J.Cureus. 2020 May 5;12(5):e7980. doi: 10.7759/cureus.7980.PMID: 32523837 Free PMC article.
Persistent left superior vena cava (LSVC) is an asymptomatic congenital heart disease. It is usually found incidentally on imaging, during central line placements or while undergoing electrophysiological procedures. We present a case of a 91-year-old female who initially presented with seizures and was diagnosed with tachy-brady syndrome. She was planned to undergo dual-chamber permanent pacemaker placement. However, during the procedure, she was incidentally found to have an LSVC without a right superior vena cava. Due to challenging anatomy, her pacemaker was changed to a single-chamber atrial lead pacemaker. This case highlights the clinical implications of this unusual structural anomaly, technical difficulties that arise alongside and solutions on how to overcome these issues in the context of pacemaker implantation.
Figure 1. Venography demonstrating LSVC (solid arrow) draining to dilated CS (dotted arrow) CS: coronary sinus, LSVC: left superior vena cava
Figure 2. Pacer lead passing from LSVC (white solid arrow) to right atrium (white dotted arrow) through the CS (red dotted arrow) CS: coronary sinus, LSVC: left superior vena cava
Figure 3. Chest radiograph with a pacer lead coursing through LSVC (white solid arrow), CS (red dotted arrow), and terminating in RA (white dotted arrow) CS: coronary sinus, LSVC: left superior vena cava, RA: right atrium
Figure 4. CT of the chest with subtraction imaging demonstrating the course of pacer lead through persistent LSVC (solid arrow) and CS (dotted arrow) CS: coronary sinus, LSVC: left superior vena cava