Ould-Ahmed M, Mas B, Hautbois E, Garcia J F, Caroff P, Guiavarch M
Département d'anesthésie-réanimation et urgences, HIA Clermont-Tonnerre, rue du Colonel Fonferrier, BP 41, 29240 Brest-Naval, France.
Ann Fr Anesth Reanim. 2000 Dec;19(10):745-8. doi: 10.1016/s0750-7658(00)00319-1.
We report the unusual course of a pulmonary artery catheter through a persistent left-sided superior vena cava. After left subclavian vein cannulation and downward left-sided paramediastinum course, the Swan-Ganz catheter enters the right pulmonary artery. Haemodynamic monitoring was consistent with the diagnosis of septic shock developed by this 56-year-old woman, after cephalic duodenopancreatectomy. Persistent left-sided superior vena cava occurs in 0.5% of the population and 5-10% of patients with congenital heart diseases. It drains into the right atrium through the coronary sinus in 92% of cases and is associated with an absent right superior vena cava in 20% of cases. The left-sided superior vena cava persists when the caudal part of the left anterior cardinal vein does not degenerate. A persistent left superior vena cava may be medically relevant during implantation of pacemaker leads or radiofrequency ablation, during cardiac surgery for placement of a retrograde coronary sinus cardioplegia catheter and during transjugular intrahepatic portosystemic shunt placement.
我们报告了一例肺动脉导管经持续存在的左侧上腔静脉走行的罕见病例。在左锁骨下静脉置管并向左下纵隔走行后，Swan - Ganz导管进入右肺动脉。血流动力学监测结果与这名56岁女性在胰十二指肠切除术后发生感染性休克的诊断相符。持续存在的左侧上腔静脉在人群中的发生率为0.5%，在先天性心脏病患者中的发生率为5% - 10%。在92%的病例中，它通过冠状窦汇入右心房，在20%的病例中与右上腔静脉缺如相关。当左前主静脉的尾部未退化时，左侧上腔静脉持续存在。在植入起搏器导线或进行射频消融时、心脏手术中放置逆行冠状窦心脏停搏液导管时以及经颈静脉肝内门体分流术放置过程中，持续存在的左侧上腔静脉可能具有医学相关性。
