The venous U-turn: a unique variant of total anomalous superior systemic venous return

A 74-year-old male patient was planned for a permanent pacemaker implantation for a bradycardiac atrial fibrillation after successful aortic valve replacement. Intra-operatively, advancing the ventricular lead via the right cephalic vein, it was impossible to reach the right atrium ( Panel A ). Suspecting an anomaly of the venous system, a phlebography was performed …