Paul W, Beisel B, Krug A, Vagt A, Timpe A, Brase R, Leitz K H, Böhmert F, Kuckelt W
Zentrum für Anaesthesiologie, Zentralkrankenhaus Links der Weser, Bremen.
Anaesthesist. 2000 Jan;49(1):25-8. doi: 10.1007/s001010050005.
A 36-year old woman was presented to our hospital with congenital ventricular septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction, a transesophageal echocardiographic (TEE) baseline examination was performed, showing a severely dilated coronary sinus (CS) measuring approximately 3 cm (abnormal >1 cm). We suggested a persistent left superior vena cava (PLSVC) draining into the CS. PLSVC is a common venous congenital anomaly, with a reported incidence of 0.5% in general population and in 3-5 % of patients with congenital heart defect. Injection of echo-contrast solution in a left arm vein, visualizing microbubbles passing through the PLSVC into the CS confirmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contraindication for retrograde cardioplegia because of the loss of cardioplegia into the PLSVC resulting in a inadequate myocardial protection. It may be difficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrhythmias. A chest radiograph shows the anomalous course of the PAC along the left heart.
一名36岁女性因先天性室间隔缺损和单支冠状动脉疾病（左主干冠状动脉近端75%狭窄）入我院，拟行冠状动脉旁路移植术（CABG）及室间隔缺损修复术。诱导麻醉后，进行了经食管超声心动图（TEE）基线检查，显示冠状静脉窦（CS）严重扩张，直径约3 cm（正常>1 cm）。我们怀疑存在持续左上腔静脉（PLSVC）引流至CS。PLSVC是一种常见的先天性静脉异常，据报道在普通人群中的发生率为0.5%，在先天性心脏病患者中的发生率为3 - 5%。经左臂静脉注射超声造影剂，可见微泡经PLSVC进入CS，证实了我们的怀疑。PLSVC合并CS扩张的诊断是逆行心脏停搏的禁忌证，因为心脏停搏液会经PLSVC流失，导致心肌保护不足。经左颈内静脉或左锁骨下静脉置入肺动脉导管（PAC）可能困难，且可能与心律失常有关。胸部X线片显示PAC沿左心走行异常。
