Open Access

CASE REPORT

Persistent Left Superior Vena Cava with Severely Dilated Coronary Sinus: A Rare Case Report of Failed CRT-P and Successful Dual-Chamber Pacemaker Implantation

Khaled Elenizi¹, Abdullah Sharaf Aldeen², Nasser Alotaibi^3,*, Nagy Fagir², Hussien Hado², Mubarak Aldossari²

1 Department of Internal Medicine, College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia
2 Department of Cardiology, King Saud Medical City Hospital, Riyadh, 12746, Saudi Arabia
3 College of Medicine, Prince Sattam bin Abdulaziz University, Alkharj, 11942, Saudi Arabia

* Corresponding Author: Nasser Alotaibi. Email:

Congenital Heart Disease 2025, 20(5), 539-546. https://doi.org/10.32604/chd.2025.071226

Received 02 August 2025; Accepted 04 November 2025; Issue published 30 November 2025

Abstract

Persistent left superior vena cava (PLSVC) is a rare congenital anomaly that may complicate cardiac procedures when associated with a dilated coronary sinus (CS) and conduction disturbances. We report the case of a 27-year-old male with Wilson’s disease who presented with complete heart block. Echocardiography showed biatrial enlargement and severe CS dilation, while contrast-enhanced computed tomography (CT) confirmed PLSVC draining into the CS without a bridging vein. Anatomical constraints prevented cardiac resynchronization therapy, and dual-chamber pacemaker implantation proved technically challenging due to lead placement difficulties. This case highlights the importance of thorough preoperative assessment and individualized pacing strategies in patients with PLSVC, in order to anticipate anatomical challenges and optimize outcomes.

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Keywords

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