Anomalies of cardiac venous drainage associated with abnormalities of cardiac conduction system

Abstract

The embryological development of the superior vena cava (SVC) is complex. If the left common cardinal vein fails to occlude it can, along with the left duct of Cuvier form a left SVC, which frequently drains into the coronary sinus. This may result in abnormalities in the anatomy of this structure. A persistent left SVC occurs in 0.5% of the normal population, and 3% to 4.3% of patients with congenital heart anomalies. The pacemaking tissue of the heart is derived from two sites near the progenitors of the superior vena cava. The right-sided site forms the sinoatrial node, the left-sided site is normally carried down to an area near the coronary sinus. Out of 300 patients with cardiac rhythm abnormalities, who have undergone electrophysiological studies (EPS), or permanent pacemaker insertion (PPI), we identified 12 patients with cardiac conduction abnormalities and anomalies of venous drainage. Anomalies of the coronary sinus may be associated with abnormalities of the conduction system of the heart. This may be due to the close proximity of the coronary sinus to the final position of the left-sided primitive pacemaking tissue. In our series of 300 patients, 4% had an associated left SVC, a similar incidence to that found in previous studies of congenital heart disease.

Atrial Fibrillation Originating From Persistent Left Superior Vena Cava

“…In the embryonic heart, bilateral pacemaking areas are present near the sinus horns and common cardinal veins. 7 Whereas the right side takes over cardiac pacemaking function as the sinoatrial node, persistence of the left common cardinal vein as the LSVC may be associated with continuing presence of pacemaker tissue and hence ectopic pacemaker activity.…”

“…The VOM is located within a vestigial fold of pericardium, the ligament of Marshall (LOM), which is the developmental remnant of the embryonic left superior vena cava (LSVC). 1,6 Rarely, the LSVC can persist, especially with congenital heart disease, and has been previously associated with some arrhythmias 7 but not with AF. In the present investigation, we studied 5 patients in whom the LSVC was demonstrated to be a source of AF.…”

Long-term follow-up after pacemaker implantation via persistent left superior vena cava

“…Thus, the electrical properties of PLSVC may play a role in the genesis of atrial tachyarrhythmias. The prevalence of accessory pathways in the group of patients with PLSVC is higher than in general population [18]. Most often, these are left free wall and posteroseptal pathways, which are remnants of incomplete separation of myocardium between atria and ventricles by the annulus fibrosis during cardiogenesis.…”

Agenesia de cava superior associada a bloqueio atrioventricular de 3º grau

“…The association between left superior vena cava and abnormal rhythm patterns may be more than chance [4]. Once the diagnosis of complete atrioventricular block was made, it was chosen to implant a ventricular-pacing pacemaker.…”