A rare vascular anomaly in the form of double left brachiocephalic vein detected incidentally during cardiac implantable electronic device (CIED) placement

Abstract

The growing number of transvenous cardiac implantable electronic device (CIED)implantation

Double left brachiocephalic veins with vascular ring and normal intracardiac anatomy: Prenatal diagnosis of a rare association

“…In the few reported cases, the anterior LBV superior to the aortic arch is usually present but multiple variants of the course of the other LBV have been described such as retro aortic course 3 as in our case, retroesophageal, 4 and anterior to the aortic arch parallel to the normal LBV 2 …”

“…Chen et al suggested the existence of a double interprecardinal anastomoses in embryonic life, a cephalic ventral, and another caudal dorsal with regression of the dorsal component and the ventral from the normal LBV but the additional branch might be caused by the remnants of the dorsal anastomosis. 1In the few reported cases, the anterior LBV superior to the aortic arch is usually present but multiple variants of the course of the other LBV have been described such as retro aortic course 3 as in our case, retroesophageal,4 and anterior to the aortic arch parallel to the normal LBV 2. The diagnosis of double LBVs can be challenging using echocardiography or CT.…”

“…Injury of the posterior branch on BT shunts or vascular ring corrective surgery can lead to massive bleeding. Furthermore, it was reported that the insertion of intracardiac electrodes, or pacemaker, or central venous lines could be technically difficult through a left‐arm approach 2 . Therefore, parents must be counseled about the significance of remembering such anomaly on arranging invasive interventions.…”

“…The normal course of the LBV is downward and to the right in the upper chest, passing superior and anterior to the aortic arch and draining into the right superior vena cava 1 . Despite the presence of numerous LBV anomalies, double LBVs are considered an extremely rare systemic venous anomaly 2 …”

“…1 Despite the presence of numerous LBV anomalies, double LBVs are considered an extremely rare systemic venous anomaly. 2 In most reported cases, double LBCVs were discovered accidentally on investigating associated cardiovascular anomalies or rhythm disorders. [2][3][4][5] In the current work, we report for the first time associated double LBCVs with a vascular ring in a fetus with further assessment after birth.…”