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.
Insights
Venous occlusion from lead implantation can cause collateral circulation, including reopening of the left superior vena cava (SVC). This case demonstrates successful lead placement via the left SVC despite anatomical challenges.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Transvenous lead implantation for cardiac devices can lead to venous occlusion.
- Occlusion may result in the development of collateral circulation.
- Reopening of a previously occluded left superior vena cava (SVC) is a rare complication.
Observation:
- A patient with worsening heart failure underwent revision of a dislodged left ventricular lead.
- Venography during the procedure revealed occlusion of the right SVC.
- A previously closed left SVC was found to have reopened.
Findings:
- Successful left ventricular lead placement was achieved via the reopened left SVC.
- This demonstrates the potential for obliterated venous structures to recanalize after occlusion.
- It highlights an alternative anatomical pathway for lead implantation.
Implications:
- Obliterated venous pathways can reopen, presenting unexpected anatomical possibilities.
- While a right-sided approach is standard, a left SVC approach is feasible for lead implantation.
- This case expands understanding of venous collateral circulation post-lead implantation.
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.
More Related Videos
07:56Closed Chest Biventricular Pressure-Volume Loop Recordings with Admittance Catheters in a Porcine Model
Published on: May 18, 2021
13:10Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
Published on: April 24, 2017
Related Concept Videos
01:21Cardiac Catheterization II: Right Heart Catheterization
01:24Cardiac Catheterization III: Left Heart Catheterization
01:21Coronary Circulation
Coronary circulation begins at the base of the aorta, where two main arteries arise—the left and right coronary arteries. These arteries encircle the heart in the coronary sulcus and supply the...
01:11Overview of Systemic Veins
The coronary sinus, the heart's principal vein, resides in the coronary sulcus on the heart's posterior aspect. This broad venous channel receives nearly all venous blood from the myocardium, the heart muscle. It is fed by three primary veins: the great cardiac vein, the...