Reopened Left Superior Vena Cava: A Novel Route for Left Ventricular Lead Placement
John Rickards1, Geran Maule2, Carver Arant3
1Department of Internal Medicine, Mercer University School of Medicine, Macon, Georgia, USA; Atrium Health Navicent, The Medical Center, Macon, Georgia, USA.
Background:
Venous occlusion is a complication of transvenous lead implantation and can lead to development of collateral circulation. Reopening of a previously closed left superior vena cava (SVC) has not been recorded in this context.
Case Summary:
A 71-year-old woman presented with worsening heart failure symptoms. Three years earlier, she had received a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy. During revision of a dislodged left ventricular lead, venography revealed occlusion of the right SVC and reopening of a left SVC. Despite anatomical challenges, left ventricular lead placement via the left SVC was achieved.
Discussion:
This case highlights how obliterated venous structures can reopen after occlusion. Whereas a right-sided approach is recommended for lead placement, this case highlights a successful left SVC approach.
Take-Home Messages:
Venous occlusion is a common complication of transvenous lead implantation and can lead to collateral circulation, including left SVC reopening. Although complex, lead implantation is possible.
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