Failure of left-sided implantable cardioverter defibrillator implantation due to absence of left brachiocephalic vein

Prenatal Diagnosis of a Retroesophageal Left Brachiocephalic Vein: Two Case Reports

A retroesophageal left brachiocephalic vein is an extremely rare anomaly and has only been reported in 6 postnatal cases. Two prenatally diagnosed cases are reported. On the 3-vessel view, the vein appears as an aberrant vessel transversely coursing behind the aorta and trachea, which subsequently drains into the superior vena cava, giving rise to a U-shaped configuration. On color Doppler sonography, the U sign is bicolored. This anomaly should prompt the sonographer to carefully assess for other congenital heart defects, suggest consideration for genetic testing, and alert the cardiologist because it could affect central line procedures and cardiac interventions after delivery.

Implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava

A persistent left superior vena cava was discovered in a 66-year-old man with heart failure undergoing implantation of a biventricular pacing and defibrillator device. An active fixation right ventricular defibrillator lead was placed through a curved guiding catheter. A sub-selection catheter and a guidewire allowed the engagement of a posterior-lateral branch of the coronary sinus, performance of an angiogram without an occlusive balloon, and optimal lead placement. The right atrial lead was positioned using a standard stylet. Despite the technical challenges, implantation of a biventricular pacing and defibrillator device via a persistent left superior vena cava is safe and feasible.

Persistent left superior vena cava-inferior vena caval communication complicating implantation of an implantable cardioverter defibrillator

A persistent left superior vena cava has been observed in 0.3% of the general population on autopsy. Its presence can complicate left-sided device implantation. Commonly, a LSVC connects to the right atrium via the coronary sinus. A LSVC-accessory hemiazygous-hemiazygous-inferior vena caval communication has not been described previously. The presence of such a congenital venous anomaly will prohibit a left-sided device implant.