Cardiac resynchronization therapy in patients with absent right but persistent left superior vena cava

Area of Science:

• Cardiovascular Medicine
• Congenital Abnormalities
• Medical Device Technology

Background:

• Abnormalities of the vena cava system are typically asymptomatic and discovered incidentally.
• Dilative cardiomyopathy necessitates advanced therapies like cardiac resynchronization defibrillator (CRT-D) therapy.
• Congenital venous anomalies can present challenges during cardiac device implantation.

Observation:

• A persistent left superior vena cava (PLSVC) with an absent right superior vena cava was identified during surgery.
• The patient required a cardiac resynchronization defibrillator therapy (CRT-D) for dilative cardiomyopathy.
• This anatomical variation was noted during an open-chest procedure.

Findings:

• Successful implantation of a CRT-D device using epicardial patches and pacing leads was achieved.
• The surgical approach provided safe and reliable biventricular defibrillator therapy despite the anomalous venous anatomy.
• The technique proved effective in managing a complex cardiac condition in the presence of a rare congenital anomaly.

Implications:

• This case highlights the importance of recognizing and managing congenital vena cava abnormalities during cardiac procedures.
• Epicardial lead placement offers a viable and safe alternative for biventricular pacing in patients with absent or anomalous superior vena cava.
• The findings support the adaptability of CRT-D implantation techniques for complex cardiovascular cases.