CASE REPORT OF PACEMAKER IMPLANTATION IN A PATIENT WITH ANOMALOUS DRAINAGE OF THE SUPERIOR VENA CAVA

Abstract

Background and objective: Persistent left superior vena cava (PLSVC) is a rare embryologic remnant anomaly. Mostly both superior vena cava coexist, however if there is Agenesis of the Right Superior Vena Cava (ARSVC) the venous drainage to the heart will be made to the right atrium, through the coronary sinus. Usually asymptomatic, this malformation can be detected when patients undergo procedures involving the superior vena cava. This is a case report of a patient with PLSVC and ARSVC who underwent pacemaker implantation with greater technical difficulties due to lack of preparation for the anatomical anomaly, as well as the difficulty in handling sedoanalgesia Case report: Male patient, 65 years old, with Coronary Disease, 5 years before undergoing myocardial revascularization, with 1st degree atrioventricular block (AVB). Admitted for permanent cardiac pacemaker implantation. He was admitted to the Surgical Center and received monitoring, venipuncture with a 20 G catheter, and sedoanalgesia with fentanyl and propofol was initiated. Venous puncture was performed in the right subclavian vein, but when checking the position of the guide wire, an anomalous ventricular pathway was visualized. After multiple repositioning attempts, the anomalous intraventricular pathway persisted. During manipulation, the patient presented supraventricular extrasystoles and increased demand for sedatives. When revisiting preoperative exams and found Angiotomography of the Coronary Arteries with a report of “probable PLSVC and ARSVC with anomalous drainage into the coronary venous sinus”