Implantation of Pacemaker in a Patient with Dextrocardia, Persistent Left Superior Vena Cava, TGA and Heart Block

Abstract

Congenital anomalies of the heart may generate difficul ties for cardiac invasive procedures. Dextrocardia is a rare congenital heart disease in which the apex of the heart is located on the right side of the chest. Patients with trans position of great arteries (TGA) abnormalities are at risk for complete cardiac block and usually require a permanent cardiac pacemaker in long-term follow-up. The persistent left superior vena cava (PLSCV) is a rare venous anomaly, often associated with abnormalities of the cardiac transduc tion system. It is usually seen by chance during permanent pacemaker implantation. Even if electrodes are not impos sible to be placed through this abnormal venous structure, it can be challenging. In this study, we present a permanent pacemaker implantation to a 31-year-old female patient with a combination of dextrocardia, PLSVC, and TGA due to complete heart block. Congenital anomalies of the heart can make transvenous procedures such as right heart catheterization or pacemak er implantation difficult. During embryological development, PLSVC occurs as a result of obliteration of the proximal part of the right anterior and right cardinal veins [ 1 ]. The left an terior cardinal vein creates a vena cava superior that opens to the right atrium through the left coronary sinus or direct ly to the left atrium. The persistent left superior vena cava (PLSCV) is rare but the most common systemic venous anomaly, which is 0.5% in general population and 3-10% in congenital heart defects [ 2 ]. Another anomaly is congenital dextrocardia, which is