Author + information
- Received August 7, 2009
- Accepted September 8, 2009
- Published online May 25, 2010.
Magnetic resonance venography was performed to better understand venous anatomy in a woman with failed pacemaker implantation. Compared with a healthy subject (A), her maximal intensity projection images (B)showed an absent superior vena cava (SVC [arrowhead]). The right subclavian vein (RSV) and left subclavian vein (LSV) were absent, although bilateral right subclavian arteries (RSA) and left subclavian arteries (LSA) were preserved. Upper body collateral drainage occurred though paravertebral veins, the azygous vein, and enlarged intercostal veins (*), appearing similar to arterial “rib notching” that is seen with aortic coarctation (B). Magnetic resonance imaging 3-dimensional reconstructions (healthy subject [C, Online Video 1]and patient [D, Online Video 2]) show the distorted venous anatomy. In addition to engorged intercostal veins (IC), our patient has a “bare” aorta (Ao), without superimposed SVC and right brachiocephalic vein (RBV) and left brachiocephalic vein (LBV). A cardiac resynchronization system was successfully implanted through an iliofemoral vein. With increased percutaneous interventions, cardiologists will likely confront similar anatomy in the future.
Dr. Raj is supported by National Institute of Healthgrant K23 RR020783. Dr. Rottman has received support for the Cardiac Arrhythmia Fellowship program from Medtronic Inc., St. Jude Medical, Boston Scientific Inc., and Biotronik Corporation.
- Received August 7, 2009.
- Accepted September 8, 2009.
- American College of Cardiology Foundation