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Russian Journal of Cardiology № 4 (132) Eng., 2016
PERSISTENT LEFT SUPERIOR VENA CAVA IN PATIENT WITH PAROXYSMAL ATRIOVENTRICULAR NODAL REENTRANT TACHYCARDIA
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Agnieszka Kuczaj , Piotr J. Stryjewski , Andrzej R. Tomasik , Ewa Nowalany-Kozielska , Jadwiga Nessler
Persistent left superior vena cava (PLSVC) is a rarely occurring congenital anomaly with the incidence of 0.3% in general population. this anomaly results from the persistence of the left anterior cardinal vein. In 90% of cases blood from PLSVC flows into the coronary sinus and then to the right atrium. It may complicate the placement of central vein catheters in the jugular and subclavian veins and, as such, cardiologists should be aware of the existence of this anatomic variant. Here we describe an adult patient with persistence of the left superior vena cava identified during made echocardiography test in a 57-year-old male patient with paroxysmal atrioventricular nodal reentrant tachycardia (AVNRT) who was admitted to a cardiac ward on a regular basis for ablation procedure.
Russ J Cardiol 2016, 4 (132), Engl.: 202-203
http://dx.doi.org/10.15829/1560-4071-2016-4-eng-202-203
Key words: persistent left superior vena cava, atrioventricular nodal reentrant tachycardia.
12nd Department of Cardiology, Zabrze, Medical University of Silesia, Katowice; 2Cardiology department, Chrzanow City Hospital; department of Coronary disease, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
Corresponding author. Piotr Jozef Stryjewski MD, Phd, Cardiology department, district Hospital in Chrzanow, Poland. e-mail: [email protected]
PLSVC — persistent left superior vena cava, AVNRT — atrioventricular nodal reentrant tachycardia.
Received August 07, 2015. Revision received September 14, 2015. Accepted September 21, 2015.
СТОЙКАЯ ЛЕВАЯ ВЕРХНЯЯ ПОЛАЯ ВЕНА У ПАЦИЕНТА С ПАРОКСИЗМАЛЬНОЙ АТРИОВЕНТРИКУЛЯРНОЙ УЗЛОВОЙ РЕЕНТЕРАБЕЛЬНОЙ ТАХИКАРДИЕЙ
12 1 13
Agnieszka Kuczaj , Piotr J. Stryjewski , Andrzej R. Tomasik , Ewa Nowalany-Kozielska , Jadwiga Nessler
Стойкая левая верхняя полая вена (PLSVC) является редко встречающейся врожденной аномалией с частотой 0,3% в общей популяции. Это приводит к аномалии с сохранением левой передней кардинальной вены. В 90% случаев кровь из PLSVC впадает в коронарный синус и затем в правое предсердие. Это может осложнить размещения центральных венозных катетеров в яремной и подключичной венах и, об этом анатомическом варианте кардиологи должны быть осведомлены. Здесь мы опишем взрослого пациента с сохранной левой верхней полой веной, выявленной в ходе эхокардиографии, сделанной 57-летнему пациенту мужского пола с пароксизмальной атриовентрикулярной узловой возвратной тахикардией (AVNRT), который был госпитализирован в кардиологическое отделение на регулярной основе для проведения исследования.
Российский кардиологический журнал 2016, 4 (132), Англ.: 202-203
http://dx.doi.org/10.15829/1560-4071-2016-4-eng-202-203
Ключевые слова: стойкая левая верхняя полая вена, пароксизмальная атри-овентрикулярная узловая реентерабельная тахикардия.
12nd Department of Cardiology, Zabrze, Medical University of Silesia, Katowice; 2Cardiology department, Chrzanow City Hospital; department of Coronary disease, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Польша.
A 57-year-old male patient with paroxysmal atrioventricular nodal reentrant tachycardia (AVNRT) was admitted to a cardiac ward on a regular basis for ablation procedure. The patient's history revealed fast heart rate episodes for several years, arterial hypertension treated for five years, hyperlipidemia and peptic ulcer disease. Physical examination showed a regular heart rate of 70bpm, quiet systolic murmur over the mitral valve and normal breath sounds. Resting ECG showed no abnormalities. A routine transthoracic echocardiog-raphy revealed concentric left ventricular wall thickening and moderate mitral valve regurgitation. Special attention was paid to an untypical accessory structure detected in the left atrium area (Figure 1). Transtho-racic echocardiography was performed in order to expand the diagnostic process. The investigation showed the vessel directly adjacent to the left atrium. The dop-pler examination showed flow inside the structure, yet without a visible connection with the left atrial cavity
(Figure 2). A congenital venous anomaly was suspected in the form of persistent left superior vena cava. X-ray fluoroscopy was done to confirm the type of the anomaly. Administration of contrast into the peripheral vein of the left superior limb resulted in visualization of the investigated structure followed by visualization of the coronary sinus. Electrophysiological examination was done due to AVNRT previously documented in ambulatory ECG investigations. Programmed atrial stimulation repetitively induced nodal reentrant tachycardia with a ventricular rate of 140bpm. Radiofrequency ablation of slow pathway modified the conduction and caused a lack of inducibility of the tachycardia in control programmed stimulation.
Persistent left superior vena cava (PLSVC) is a rarely occurring congenital anomaly with the incidence of 0.3% in general population [1]. In the majority of cases the anomaly is asymptomatic, but it is frequently (12%) accompanied by other malformations such as atrial septal
CLINICAL CASES
defect, ventricular septal defect, aortic coarctation, transposition of the great vessels, tetralogy of Fallot, anomalous connections of the pulmonary veins or single atrium [1, 2, 3]. In 90% of cases blood from PLSVC flows into the coronary sinus and then to the right atrium. In the remaining 10% of cases, the PLSVC is directly connected to the left atrium. Superior vena cava mostly occurs in the hypoplas-tic form (82-90%) [1]. In the presented case, PLSVC coexisted with the anomaly in the heart conduction sys-
References
1. Povoski SP, Khabiri H. Persistent left superior vena cava: review of the literature, clinical implications, and relevance of alterations in thoracic central venous anatomy as pertaining to the general principles of central venous access device placement and venography in cancer patients (Review). World J Surg Oncol 2011; 9:173.
tem — an accessory pathway in atrioventricular node causing AVNRT.
Summarizing, attention should be paid to this rare developmental anomaly due to a possible difficulty in superior vena cava access in the case of medical procedures and a possibility of the coexistence of other cardiac pathologies. In the presented case, PLSVC was accompanied by an accessory pathway in atrioventricu-lar node.
2. Granata A, Andrulli S, Fiorini F, et al. Persistent left superior vena cava: what the interventional nephrologist needs to know. J Vasc Access 2009; 10(3): 207-11.
3. Goyal SK, Punnam SR, Verma G, Ruberg FL. Persistent left superior vena cava: a case report and review of literature. Cardiovasc Ultrasound 2008; 6(1): 1-4.
