Case Report Permanent Pacemaker Implantation in an Adult Patient With a Rare Congenital Anomaly and Dilated Cardiomyopathy

A 66-year old adult male with known dextrocardia required permanent pacemaker for symptomatic bradyarrhythmia associated with recalcitrant symptomatic congestive heart failure due to dilated cardiomyopathy with four chamber enlargement. Intrahepatic interruption of left-sided inferior vena cava with azygos continuation which made a !oop in the thorax before entering into an abnormally shaped right atrium, right-sided persistent superior vena cava and hepatic veins connected directly to right atrium from below were the associated systemic venous retum abnormalities demonstrated by repeat contrast injections.