Case Report

Difficult Temporary Pacing in a Patient with Interruption of Inferior Vena Cava and Hemiazygos/Accessory Hemiazygos Continuation

Abstract

Many cardiovascular procedures such as temporary pacemaker insertion, electrophysiological studies, and percutaneous transmitral commissurotomy are carried through inferior vena cava (IVC). Its malformations such as its interruption with azygous/hemiazygous continuation, left-sided IVC, and double IVC can make some difficulties for cardiologists during these procedures. In this case report, we present the case of a 75-year-old male with recurrent episodes of syncope and bradycardia. Due to interrupted IVC, temporary pacing lead was difficultly advanced from the IVC to the accessory hemiazygos vein, left brachiocephalic vein, superior vena cava, right atrium, and right ventricle. Temporary pacemaker insertion is an invasive procedure and should be performed under the guidance of fluoroscopy. However, rarely, IVC malformations such as interrupted IVC make it difficult to do procedure in a short period of time. Rupture of IVC and some complications due to severe bradycardia can be prevented by understanding rare IVC malformations.

Standring S. Gray's anatomy: The anatomical basis of clinical practice. Philadelphia, PA: Elsevier; 2016.

Clark EB. Cardiac embryology. Its relevance to congenital heart disease. Am J Dis Child 1986; 140(1): 41-4.

Fernandez-Cuadrado J, Alonso-Torres A, Baudraxler F, Sanchez-Almaraz C. Threedimensional contrast-enhanced magnetic resonance angiography of congenital inferior vena cava anomalies. Semin Pediatr Surg 2005; 14(4): 226-32.

Ruggeri M, Tosetto A, Castaman G, Rodeghiero F. Congenital absence of the inferior vena cava: A rare risk factor for idiopathic deep-vein thrombosis. Lancet 2001; 357(9254): 441.

Sadler TW, Langman J. Langman's medical embryology. 12th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011.

Cohen MI, Gore RM, Vogelzang RL, Rochester D, Neiman HL, Crampton AR. Accessory hemiazygos continuation of left inferior vena cava: CT demonstration. J Comput Assist Tomogr 1984; 8(4): 777-9.

Fernandes R, Israel RH. Isolated azygos continuation of the inferior vena cava in the elderly. Respiration 2000; 67(2): 229-33.

Hardwick T, Belcher E, Sabharwal T, King J. Interrupted inferior vena cava: High-risk anatomy for right thoracotomy. Interact Cardiovasc Thorac Surg 2011; 12(5): 850-2.

Files
IssueVol 2 No 1 (2017): Winter QRcode
SectionCase Report(s)
Keywords
nferior vena cava abnormalities Azygos vein abnormalities Cardiac pacing
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Hajizadeh R, Sohrabi B, Akbarzadeh F, Ranjbar A. Difficult Temporary Pacing in a Patient with Interruption of Inferior Vena Cava and Hemiazygos/Accessory Hemiazygos Continuation. CRCP. 2017;2(1):24-26.