Journal Information
Vol. 34. Issue 9.
Pages 563-564 (September 2015)
Download PDF
More article options
Vol. 34. Issue 9.
Pages 563-564 (September 2015)
Image in Cardiology
DOI: 10.1016/j.repce.2015.08.011
Open Access
Left to right and right to left
À direita da veia cava superior esquerda
Anne Delgadoa,
Corresponding author

Corresponding author.
, António Tralhãob, Diogo Cavacob, Pedro Adragãob
a Centro Hospitalar Tondela-Viseu, Viseu, Portugal
b Centro Hospitalar Lisboa Ocidental-Hospital Santa Cruz, Carnaxide, Portugal
Article information
Full Text
Download PDF
Figures (1)
Full Text

A 64-year-old male with idiopathic cardiomyopathy and atrial fibrillation, previously fitted with a cardioverter-defibrillator (ICD) using a persistent left superior vena cava (PLSVC) for lead placement, was scheduled for upgrade to a cardiac resynchronization therapy-defibrillator due to new-onset left bundle branch block, heart failure and severely depressed left ventricular (LV) ejection fraction. A selective venogram of the coronary sinus from a left-sided approach revealed a sharp angulation of a lateral subsidiary target vein, precluding placement of the LV electrode in an optimal position, and leading to non-controllable diaphragmatic stimulation. A solution was devised by accessing the right subclavian vein and culminating in subcutaneous tunneling of the lead to the contralateral generator pocket. A control chest X-ray with explaining diagram (Figure 1) shows the right ventricular defibrillator lead (yellow arrowheads and dashed yellow line) following a standard left subclavian vein (LSCV) approach but going through a PLSVC draining to the coronary sinus (CS), then entering the right atrium (RA) and crossing the tricuspid valve, with its tip abutting the right ventricular (RV) apex. The LV lead is seen sequentially entering (blue arrows) the right subclavian vein (RSCV), superior vena cava (SVC), RA, CS and lateral vein. Finally, the end of the proximal LV lead (asterisks) is tunneled subcutaneously and connected to the previously placed generator in a left prepectoral position.

Figure 1

Left superior vena cava persistence can occur in up to 0.66% of device candidates and can pose technical challenges during device implantation.

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that no patient data appear in this article.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of interest

The authors have no conflicts of interest to declare.

Copyright © 2014. Sociedade Portuguesa de Cardiologia
Revista Portuguesa de Cardiologia (English edition)

Subscribe to our newsletter

Article options
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

By checking that you are a health professional, you are stating that you are aware and accept that the Portuguese Journal of Cardiology (RPC) is the Data Controller that processes the personal information of users of its website, with its registered office at Campo Grande, n.º 28, 13.º, 1700-093 Lisbon, telephone 217 970 685 and 217 817 630, fax 217 931 095, and email I declare for all purposes that the information provided herein is accurate and correct.