Europace Advance Access originally published online on June 27, 2008
Europace 2008 10(8):1026-1027; doi:10.1093/europace/eun152
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
IMAGES IN ELECTROPHYSIOLOGY
Left ventricular lead: unusual implantation failure
Department of Cardiology, Hôpital Arnaud de Villeneuve, Montpellier, France
Manuscript submitted 26 March 2008. Accepted after revision 11 May 2008.
* Corresponding author. Tel: +33 662093886. E-mail address: mathieugranier{at}hotmail.com
A 62-year-old woman with dilated non-ischaemic cardiomyopathy was referred for prophylactic cardiac resynchronization therapy defibrillator implantation. Left subclavicular vein puncture was performed without difficulty, but catheterization of coronary sinus failed. Angiography showed left superior vena cava (LSVC) leading to coronary sinus without any cardiac lateral veins (Figure 1A). Owing to acute angulation between LSVC and right ventricle, implantation of the right ventricular lead was impossible. Three-dimensional computed tomography confirmed the diagnosis and failed to demonstrate any macroscopic cardiac lateral veins (Figure 1B and C). A second procedure was performed through the right subclavicular vein to allow the right ventricular and auricular lead implantation. At the same time, a retrograde coronary sinus and LSVC angiography confirmed the absence of cardiac lateral veins. An epicardial left ventricular lead implantation through thoracoscopy was then decided (Figure 1D).
|
Persistent LSVC is a rare congenital abnormality occurring in 0.3% of the general population due to the persistence of the left anterior cardinal vein present in early embryological development.1
As LSVC connects with coronary sinus, it is usually asymptomatic, but it may be associated with other congenital malformations.2 Clinical cases often reported the presence of catheterizable left marginal vein, allowing the implantation of a left ventricular lead through LSVC.3,4 In this case, three-dimensional computed tomography was helpful to confirm the absence of both cardiac malformations and marginal cardiac vein. This intra-operative diagnosis completed by three-dimensional computed tomography highlights a rare indication of epicardial left ventricular lead implantation.
Conflict of interest: none declared.
 |
References |
|---|
 Top References |
|---|
[1] Burneya K, Youngb H, Barnardc SA, McCoubried P, Darbyd M. CT appearances of congential and acquired abnormalities of the superior vena cava. Clin Radiol (2007) 62:837–42.[CrossRef][Web of Science][Medline]
[2] Morgan DR, Hanratty CG, Dixon LJ, Trimble M, O'Keeffe DB. Anomalies of cardiac venous drainage associated with abnormalities of cardiac conduction system. Europace (2002) 4:281–7.
[3] Larsen AI, Nilsen DW. Persistent left superior vena cava. Use of an innominate vein between left and right superior caval veins for the placement of a right ventricular lead during ICD/CRT implantation. Eur Heart J (2005) 26:2178.
[4] Ferrero A, Ruiz-Granell R, Morell S. Implantation of a cardiac resynchronization system in a patient with a persistent left superior vena cava. Rev Esp Cardiol (2007) 60:1104–6.[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||