Vol 30, No 2 (2023)
Image in Cardiovascular Medicine
Published online: 2023-04-17

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Isolated persistent left superior vena cava: A rare and unexpected finding in a patient with COVID-19 and complete heart block

Dawid Miśkowiec1, Paweł Życiński1, Haval D. Qawoq1, Jarosław D. Kasprzak1
Pubmed: 37083169
Cardiol J 2023;30(2):327-328.


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Cardiology Journal

2023, Vol. 30, No. 2, 327–328

DOI: 10.5603/CJ.2023.0020

Copyright © 2023 Via Medica

ISSN 1897–5593

eISSN 1898–018X

Isolated persistent left superior vena cava: A rare and unexpected finding in a patient with COVID-19 and complete heart block

Dawid MiśkowiecPaweł ŻycińskiHaval D. QawoqJarosław D. Kasprzak
Department of Cardiology, Medical University of Lodz, Poland

Address for correspondence: Dawid Miśkowiec, MD, Department of Cardiology, Medical University of Lodz,
ul. Kniaziewicza 1/5, 91–347 Łódź, Poland, tel: +48 42 251 62 16, fax: +48 42 653 99 09,
e-mail: dawid.miskowiec@gmail.com

Received: 4.06.2022 Accepted: 27.01.2023

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

Contained in this report is the case of a 90-year-old man with a loss of consciousness, fever and cough. The electrocardiogram showed third degree atrio-ventricular block with 30 bpm ventricular escape rhythm, with no reversible causes. A transvenous pacing was attempted and after positive SARS-CoV-2 PCR he was transferred to a referral hospital with a “COVID-Cardiology” unit. Transthoracic echocardiography (TTE) showed preserved left ventricular systolic function and dilated coronary sinus (CS). D-dimer was elevated and the computed tomography (CT) pulmonary angiogram showed subsegmental pulmonary emboli, without typical COVID-19 pneumonia.

The patient underwent pacemaker (PCM) implantation under high level protective measures. During the procedure, the course of vascular sheath introducer guidewires suggested the presence of persistent left superior vena cava (PLSVC), confirmed intra-procedurally by re-evaluation of CT angiography (not included in the routine report) (Fig. 1, Suppl. Video 1). Unexpectedly, right superior vena cava (SVC) was not found confirming isolated PLSVC with absent right SVC. Finally, dual chamber PCM was implanted without complications via PLSPV communicating with right atrium by humongous CS (30 mm). TTE with contrast use proved venous drainage from the right arm via left brachiocephalic bridging vein and PLSVC through the extremely dilated CS into the right atrium. The patient was discharged home in good condition.

Figure 1. A. Transthoracic echocardiography (TTE), modified apical 4-chamber view showing the pacemaker leads (red arrow) entering via dilated coronary sinus into the right atrium (RA); B. An unenhanced image is on the top; after 2nd generation ultrasound enhancing agent injection via the right antecubital vein entire inflow into the RA occurs via dilated coronary sinus (CS) (right panel), suggestive for isolated persistent left superior vena cava (PLSVC); C. Computed tomography 3-dimensional angiogram (left anterior oblique view) showing the isolated PLSVC (double arrows), without right superior vena cava and drainage of the right subclavian vein via bridging vein through PLSVC (red arrows) into CS (yellow arrow); RV right ventricle; LA left atrium; LVleft ventricle; Ao aorta; MPA main pulmonary artery.

This is the first report of isolated PLSVC in a patient undergoing PCM implantation during the highly demanding COVID-19 pandemic. PLSVC is observed in 0.30.5% of the population, but in > 90% the right homologue persists (“double SVC”). The present case highlights the importance of recognizing rare anatomical obstacles during PCM implantation and methods of dealing with them.

Conflict of interest: None declared