Superior vena cava syndrome due to permanent transvenous pacemaker electrodes: successful treatment with combined thrombolysis and angioplasty--a case report.

Superior vena cava syndrome is a rare complication of permanent transvenous pacing electrodes. Multiple treatment options are available, namely thrombolytics, venoplasty, stenting, surgery, and combinations of the above, yet initially the optimal approach is uncertain. Whether plain balloon angioplasty provides durable and satisfactory long-term results is equally uncertain. The authors report a patient treated with a combination of local thrombolytic therapy and balloon venoplasty with good long-term outcome at two years of follow-up.

Systolic excursion of the mitral annulus to assess septal function in paradoxic septal motion.

To determine whether mitral valve annulus displacement (MVAD) can be used to assess septal contractility in patients with paradoxical septal motion, we assessed four atrioventricular regions (septum, lateral wall, anterior wall, and inferior wall) by MVAD in 80 consecutive patients. The patients were divided into five groups: group 1 (control) (n = 20), normal left ventricular (LV) systolic function; group 2 (n = 15), paradoxical septal motion resulting from left bundle branch block (LBBB) and normal segmental and global LV systolic function; group 3 (n = 19), paradoxical septal motion as a result of cardiac surgery, and normal segmental and global LV systolic function; group 4 (n = 11), paradoxical septal motion resulting from LBBB, dilated cardiomyopathy, and severely depressed LV systolic function; group 5 (n = 15), septal hypokinesis with either normal or mildly depressed global LV systolic function. In groups 1, 2, and 3, 80% to 100% of patients had septal and other regional MVAD > or = 1.0 cm. The average MVAD in group 4 (dilated cardiomyopathy), was significantly decreased ( < or = 0.8 cm) in all four regions (p < 0.01 compared with groups 1, 2, and 3). In group 5 (septal hypokinesis), the septal MVAD was > or = 1.0 cm in only 13% of the patients (p < 0.025 compared with groups 1, 2, and 3). In conclusion, patients with paradoxical septal motion caused by LBBB or cardiac surgery have preserved septal contractility when evaluated by MVAD.