Marca-Passo Artificial

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Persistent Left Superior Vena Cava in Permanent Pacemaker Implantation

Jerson Hernando Quitián et al. José Julian Carvajal Mariana Soto Guillermo Mora

This was an 84-year-old male patient, with worsening functional class from NYHA III/IV to IV/IV and palpitations. No syncope. Physical examination revealed bradycardia, the rest was uneventful. Electrocardiogram showed Mobitz II atrioventricular block. Patient was scheduled for permanent pacemaker implantation.

Subclavian vein access was performed via direct puncture. The guide wire was advanced, entered the subclavian vein and descended parallel to the spine without crossing over to the right side. Subsequently, the guide wire traversed the coronary sinus and ended in the right atrium. Persistent left superior vena cava was diagnosed. During fluoroscopic observation, another feature that aids in the diagnosis is left paravertebral shadow above the aortic bow. The electrode was initially introduced with a straight guide reaching into the right atrium (RA). Afterwards, the straight guide was replaced by a conventional J guide and the electrode was pushed towards the anterolateral wall of the RA. The electrode tip was thus lying against the tricuspid valve. Subsequently, the guide was withdrawn 3 cm. The guide withdrawal, without moving the electrode, is associated with the passage of the electrode through the tricuspid valve. The electrode was advanced and finally the active fixation mechanism was deployed.

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Anatomopathological Session

Case 3/2015 – 53-Year-Old Female with Cardiogenic Shock 12 Years after Surgical Correction of Endomyocardial Fibrosis

Michel Abi Kalansky Ponczek et al. Fernanda Seligmann Feitosa Léa Maria Macruz Ferreira Demarchi

Clinical aspects

At the age of 29 years, the patient developed palpitations, which, after 5 years, associated with dyspnea on exertion, which progressed slowly until the age of 39 years. In young patients, the major causes of heart failure (HF) are idiopathic dilated cardiomyopathy, myocarditis, Chagas disease, alcoholic cardiomyopathy, and, more rarely, ischemic heart disease. In addition, rarer causes of HF in patients of tropical and subtropical regions, such as EMF, are worthy of note.

When the patient first sought the hospital, she was diagnosed with EMF, which is an uncommon restrictive cardiomyopathy, accounting for 1.6% of the deaths due to cardiac disease in Brazil. It is more common in the eastern and central regions of Africa. Several cases have been reported in South America and India, and sporadic ones have been reported worldwide. In some places, EMF has an endemic distribution.

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Persistent Left Superior Vena Cava in Permanent Pacemaker Implantation

Case 3/2015 – 53-Year-Old Female with Cardiogenic Shock 12 Years after Surgical Correction of Endomyocardial Fibrosis

Clinical aspects

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)