Korean Circ J.  2008 Feb;38(2):128-130. 10.4070/kcj.2008.38.2.128.

Successful Pacemaker Revision Through Sustained Right Superior Vena Cava in a Patient With Situs Inversus Totalis

• Kim HL
• Kim MK
• Min HS
• Choi BY
• Choi EK
• Kwak JJ
• Choi YS
• Oh S

• KMID: 2225855
• DOI: http://doi.org/10.4070/kcj.2008.38.2.128

Abstract

In patients with situs inversus totalis, the superior vena cava is normally positioned on the left side and drains into a left-sided right atrium (RA). If right-side superior vena cava (RSVC) is also present, it should be thought of as a combined congenital anomaly. Here, we report a case of successful pacemaker lead insertion through the RSVC in a patient with situs inversus totalis. The left-side superior vena cava (LSVC) had been already used as a route for the first pacemaker lead insertion 15 years earlier. During the pacemaker lead revision, we found that the LSVC was obliterated, and used the RSVC as a route for a new pacemaker lead insertion.

Keyword

Vena cava, superior; Situs inversus; Pacemaker, artificial

MeSH Terms

Heart Atria
Humans
Pacemaker, Artificial
Situs Inversus
Vena Cava, Superior

Figure

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  Fig. 1 Initial chest X-ray on admission. The chest X-ray showed situs inversus totalis.

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  Fig. 2 Initial ECG on admission. Tall pacing spikes resulted from ventricular pacing with high output. ECG: electrocardiography.

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  Fig. 3 Pacemaker revision through RSVC. In Figure A, the previously inserted pacemaker lead is shown in the LSVC (arrows). However, the LSVC was not visualized below the level of the most inferior arrow in this figure, and we could not pass a guide wire in order to insert a new pacemaker lead. However, the RSVC drained into the right atrium via the coronary sinus, and we were able to insert a guide wire into the left-sided right ventricle (B). Arrowheads indicate the venous drainage route to the RSVC. LSVC: left superior vena cava, RSVC: right superior vena cava.

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  Fig. 4 Chest X-ray after the procedure. The chest X-ray after successful pacemaker revision showed that the new pacemaker lead (arrowheads) was positioned in the right ventricular apex through the RSVC. RSVC: right superior vena cava.

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  Fig. 5 ECG during the 1-month follow-up after pacemaker revision. This ECG shows a well-functioning pacemaker. ECG: electrocardiography.

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