Transvenous dual chamber pacing via a unilateral left superior vena cava

Transjugular intrahepatic portosystemic shunt with accidental diagnosis of persistence of the left superior vena cava

Transjugular intrahepatic portosystemic shunt (TIPSS) is considered a valid therapeutic option for the treatment of portal hypertension and its complications. The guidelines for this procedure have already been established on the basis of the normal vascular anatomy and of various technical radiological aspects. In some few rare cases, diagnosis of a congenital vascular anomaly can be made accidentally by interventional radiologists, making the procedure of the TIPSS placement extremely difficult or in some cases technically impossible. This report describes a rare vascular malformation characterized by the absence of the right superior vena cava and persistence of the left superior vena cava in a patient with a diagnosis of advanced liver cirrhosis who needed a TIPSS placement in order to control refractory ascites.

Third-degree atrioventricular block and unusual superior vena cava abnormality

During the implantation of a definitive pacemaker for complete atrioventricular block via the left subclavian vein, a rare and abnormal origin of the superior vena cava was detected. No such finding has ever been reported, leading us to adopt the contralateral approach.

[Unusual course of a pulmonary artery catheter through a persistent superior vena cava]

We report the unusual course of a pulmonary artery catheter through a persistent left-sided superior vena cava. After left subclavian vein cannulation and downward left-sided paramediastinum course, the Swan-Ganz catheter enters the right pulmonary artery. Haemodynamic monitoring was consistent with the diagnosis of septic shock developed by this 56-year-old woman, after cephalic duodenopancreatectomy. Persistent left-sided superior vena cava occurs in 0.5% of the population and 5-10% of patients with congenital heart diseases. It drains into the right atrium through the coronary sinus in 92% of cases and is associated with an absent right superior vena cava in 20% of cases. The left-sided superior vena cava persists when the caudal part of the left anterior cardinal vein does not degenerate. A persistent left superior vena cava may be medically relevant during implantation of pacemaker leads or radiofrequency ablation, during cardiac surgery for placement of a retrograde coronary sinus cardioplegia catheter and during transjugular intrahepatic portosystemic shunt placement.

Dual chamber pacemaker implantation via a double superior vena cava

We present the chest X ray of a woman with sinoatrial node disease. She has had a dual chamber pacemaker implanted with each lead coursing through a separate superior vena cava.