We report two young patients with symptomatic sick sinus syndrome admitted for permanent pacemaker implantation (PPI). On evaluation with echocardiography, one of them was found to have persistent left superior vena cava and venography showed absent right superior vena cava also. He underwent PPI with leads inserted via left superior vena cava, coronary sinus, right atrium and right ventricle. The other patient was incidentally found to have interrupted inferior vena cava with azygos continuation while being planned for temporary pacemaker implantation. She underwent successful PPI. We would like to stress the importance of having a high suspicion for these systemic venous anomalies in patients presenting with sick sinus syndrome especially at young age. If we could diagnose preoperatively, we can avoid on table surprises.

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Anaphylactic shock in periprocedural period poses diagnostic and therapeutic challenge. Here we report a case of severe mitral stenosis developed sudden cardio respiratory arrest after parenteral antibiotic injection while being prepared for elective balloon mitral valvotomy. After initial resuscitation patient was taken up for emergency balloon mitral valvotomy in view of refractory shock. Patient developed air embolism during the procedure in view of reduced right atrial pressure which was successfully managed. She underwent balloon mitral valvotomy. Patient developed renal failure and deranged haematological parameters which were managed accordingly, finally the patient made a complete recovery.