Superior vena cava syndrome: an increasingly frequent complication of cardiac procedures.

BACKGROUND: A 29-year-old woman presented with chest pressure, progressive dyspnea, fatigue, and swelling of her face, neck and upper extremities. Four days earlier, she had undergone a procedure for treatment of inappropriate sinus tachycardia, during which atrioventricular node ablation and implantation of a single-lead VVI pacemaker had been performed following an unsuccessful attempt at sinus node modification. INVESTIGATIONS: Physical examination, contrast-enhanced CT of the chest, Doppler ultrasonography of the upper extremities, venography, coagulation studies, echocardiography. DIAGNOSIS: Superior vena cava syndrome due to thrombotic obstruction-a complication of a cardiac procedure. MANAGEMENT: Anticoagulation, catheter-directed thrombolytic therapy, mechanical thrombectomy, pericardiocentesis.