Reopened Left Superior Vena Cava: A Novel Route for Left Ventricular Lead Placement.

BACKGROUND

Venous occlusion is a complication of transvenous lead implantation and can lead to development of collateral circulation. Reopening of a previously closed left superior vena cava (SVC) has not been recorded in this context.

CASE SUMMARY: A 71-year-old woman presented with worsening heart failure symptoms. Three years earlier, she had received a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy. During revision of a dislodged left ventricular lead, venography revealed occlusion of the right SVC and reopening of a left SVC. Despite anatomical challenges, left ventricular lead placement via the left SVC was achieved.

DISCUSSION: This case highlights how obliterated venous structures can reopen after occlusion. Whereas a right-sided approach is recommended for lead placement, this case highlights a successful left SVC approach.

TAKE-HOME MESSAGES: Venous occlusion is a common complication of transvenous lead implantation and can lead to collateral circulation, including left SVC reopening. Although complex, lead implantation is possible.