Implication of a Persistent Left Superior Vena Cava in Transvenous Pacemaker Therapy and Cardiac Hemodynamic Monitoring

¹ Section of Cardiovascular Diseases, Department of Medicine and the Department of Surgery, Mt. Sinai Hospital of Detroit

An anomalous persistent left superior vena cava may complicate the insertion of transvenous pacemaker electrode catheters as well as the catheterization of the pulmonary artery. It is important to recognize the anomaly because of the ease of confusing the position of the catheters passing through the coronary sinus into a distal coronary vein rather than the right ventricular apex. If the condition is known and is associated with a patent right superior vena cava, a catheter or electrode should probably be passed from the right side. If this is not possible, our experience indicates that the flow-directed balloon-tipped catheter (Swan-Ganz) can be passed easily without fluoroscopic control through an anomalous left superior vena cava to the pulmonary artery. Using a similar balloontipped flow-directed pacemaker electrode may be help ful in its positioning in the apex of the right ventricle. While short-term temporary pacing via the coronary sinus is probably acceptable, placement of a permanent electrode in the coronary sinus is dangerous. If there is congenital absence of the right superior vena cava, an epicardial electrode is likely preferred.

This article has been cited by other articles:

				M. Biffi, G. Boriani, L. Frabetti, G. Bronzetti, and A. Branzi Left Superior Vena Cava Persistence in Patients Undergoing Pacemaker or Cardioverter-Defibrillator Implantation : A 10-Year Experience Chest, July 1, 2001; 120(1): 139 - 144. [Abstract] [Full Text] [PDF]