Superior Vena Cava Malformations: Diagnosis and Technique for Endocavitary Electrode Implantation in Permanent Cardiac Pacing
Keywords:
Congenital malformations, Superior vena cava, Persistent left superior vena cava, Pacemaker implantationAbstract
Introduction: The implantation of endocavitary electrodes for permanent cardiac pacing requires specialized skills and knowledge regarding the anatomy of the superior venous vessels that drain into the right atrium. The superior vena cava typically courses to the right of the vertebral column before draining into the right atrium. However, it may present anatomical variants —such as a Persistent Left Superior Vena Cava (PLSVC)— that pose a challenge for the specialist.
Objective: To describe the clinical and imaging characteristics of patients with superior vena cava system malformations due to the technical difficulties these present for endocavitary electrode implantation.
Method: Five patients, aged 36 to 72 years, were studied. These patients were referred for pacemaker implantation, but the initial procedure was unsuccessful due to anatomical and technical challenges. An imaging study protocol was established and applied on a case-by-case basis.
Results: Three patients were diagnosed with PLSVC plus absence of the right superior vena cava, and two others with a dual superior vena cava. Novel electrode implantation techniques, not previously described in the literature, were established and successfully applied to achieve endocavitary implant success.
Conclusions: Knowledge of the anatomical variants of this malformation, the diagnostic modalities, and the techniques for endocavitary electrode implantation are of vital importance for achieving procedural success. Specialists who identify that the electrode descent is via the left paravertebral region should establish similar diagnostic protocols and master these implantation techniques.
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