Venoplasty of Innominate Bridge during Implantation of Single‐Chamber ICD in a Patient with a Persistent Left‐Sided Superior Vena Cava

Abstract

The persistent left-sided superior vena cava (PLSVC) is a common congenital abnormality, occurring in approximately 1% of patients. The presence of a PLSVC can complicate the implantation of a pacemaker or an automatic implantable cardioverter-defibrillator (AICD). In this case, we report a procedure, venoplasty of an innominate branch, to facilitate implantation of a right ventricular lead in a single-chamber AICD. This approach could potentially reduce procedure and fluoroscopy time in other similar cases.

What’s in a Name? Utilization of the Innominate Vein for Pacemaker Lead Placement in the Setting of Persistent Left Superior Vena Cava

“…A search for a bridging innominate vein may be advantageous for the placement of the RV lead, and it has been shown that even with negative antegrade venography, a retrograde venogram can be revealing [7]. Where the innominate vein appears stenotic, venoplasty has been described to facilitate placement of the RV lead as well [8]. Alternatively, if anomalous PLSVC-CS anatomy is known or suspected in advance, based for example on a dilated CS detected on echocardiography, a right pectoral approach may be considered if RSVC is present.…”

Transvenous defibrillator implantation in a patient with persistent left superior vena cava

“…Few operators have used additional subcutaneous patch [8,9] or defibrillation coil [10] for the optimal defibrillation potential. Even, Tauras et al [11] had performed innominate vein angioplasty to put defibrillation lead via right SVC in a patient with LSVC. As there was absent bridging innominate vein in the index case ( Figure 1B), we could not approach to right SVC from left side.…”