Absence of the Superior Vena Cava: Difficulties for Pacemaker Implantation

Abstract

Endocardial pacemaker electrode implantation can be difficult in patients with anomalous superior vena cava (SVC). Venography and CAT scan showed that the patient lacked SVC venous drainage and that systemic veins drained into the inferior vena cava through the azygos vein. A temporary stimulation electrode was placed by puncture of the femoral vein, permanent stimulation by venotomy of the epigastric vein, with the electrode inserted through the external iliac vein.

Bilateral Absence of the Superior Vena Cava

“…In the other four cases, as in the present case, an anastomosis between the left and right was only in the azygos system, with no upper communicating vein caudal to the aortic arch [5, 6, 8, 10]. Four different types of connections have been described from the azygos system into the right atrium: the azygos veins drain directly into the IVC, as in the present case [3, 5, 6, 10], and they drain into the left renal vein [8, 9], into the right atrium as in case of the absence of the hepatic segment of the IVC with azygos continuation [11], into the right atrium via a complex subdiaphragmatic plexus of veins without a clear, demonstrable communication with the IVC [2]. …”

“…To our knowledge, only ten previously cases are published that show the total absence or severe hypoplasia of the SVC (Table 1) [2–11]. The first two were adults, diagnosed by venography during an attempt to implant a pacemaker [2, 3]. One adult case was diagnosed because of complicated vascular access during an electrophysiological evaluation for ablation purpose [11].…”

Bilateral absence of the superior vena cava presenting with superior vena cava syndrome: A case report

“…5 Two adults were diagnosed by venography during an attempt to implant a pacemaker for complete atrioventricular block. 6,7 Bilateral absence of the SVC was detected in a newborn during the diagnosis of a cardiac murmur 8 and was associated with tetralogy of Fallot in a child. 9 Four newborns were diagnosed with bilateral absence of the SVC after exhibiting varying degrees of chylothorax, edema, and respiratory distress, which were seemingly alleviated after palliative treatment.…”

Absent superior vena cava in tetralogy of fallot

“…On reviewing the literature, 11 cases of SVC interruption were reported and some of them were diagnosed during cardiac catheterization. [ 2 3 4 ] Looking back in our case, innominate and IVC cannulation achieved excellent drainage for CPB. We could have done the same with one cannula alone in IVC.…”