Injection Through the right antecubital vein; (C) opacification was seen
in CS before reaching RA
Procedure was tried one more time guided TEE. After adequate prep and
drape, four access were obtained from right femoral vein. Then catheters
passed into the veins and lead tip placed in RA, RV, His and CS. A
guiding passed from interatrial septum (septostomy was done via TEE
guiding) and ablation catheter was inserted in LA.
The earliest retrograde atrial activation was recorded in the CS 7-8.
Radio-frequency (RF) energy delivered to posterior ring of MV, but could
not eliminate the bypass tract; however, the ablation site changed to
posteromedially site of MV and posterolaterally site but ablation was
failed again. Irrigated catheter exited from LA and was inserted in CS,
ablation was done in 4 o’clock to 5 o’clock region of the mitral annulus
which not resulted to VA dissociation. Because of instability of the
ablation catheter and inaccurate repositioning during ablation, for
evaluation of systemic venous anomalies an access was inserted in left
subclavian vein, guiding fluoroscopy, then contrast was injected, the
findings included sever dilation of CS with abnormal drainage of right
venosus system (Fif-3), as the patient had no right SVC. Right venosus
system drained into left persistent SVC.