Monami C, Martinez C, Ghuysen A, D'Orio V
Service d'Urgences, Université de Liège.
Rev Med Liege. 2000 Oct;55(10):905-9.
We report the case of a 48-year-old man who was admitted to our emergency department because of a superior vena caval syndrome from which the symptoms occurred only during exercise. His past history included an episode of lower limb deep venous thrombosis. Because an atrio-ventricular partial block was fortuitously evidenced, the patient was submitted to a pacemaker insertion. A few years later, the patient suffered from rapid dyspnea on exercise, associated with facial cyanosis and systemic hypotension. The exploration by phlebography evidenced that the inferior vena cava was completely obstructed. Therefore the venous return from the lower part of the body to right heart was obtained through hypertrophy of the vena azygos. In addition, the presence of cardiac pacing electrodes induced a stenosis at the level of the superior vena cava, just before its entrance into the right atrium. Such a venous network accounted for the occurrence of a chronic superior vena caval syndrome associated with peripheral arterial hypotension during exercise. Treatment consisted of a superior vena caval percutaneous transluminal balloon angioplasty followed by a Wallstent insertion. This procedure led to a correction of all hemodynamic abnormalities responsible for reported pathophysiological limitations to stress.
我们报告了一名48岁男性的病例，该患者因仅在运动时出现症状的上腔静脉综合征而入住我院急诊科。他的既往史包括一次下肢深静脉血栓形成发作。由于偶然发现了房室传导阻滞，该患者接受了起搏器植入术。几年后，患者在运动时出现快速呼吸困难，伴有面部发绀和全身低血压。静脉造影检查显示下腔静脉完全阻塞。因此，身体下部至右心的静脉回流是通过奇静脉扩张实现的。此外，心脏起搏电极的存在导致上腔静脉在进入右心房之前的水平处出现狭窄。这样的静脉网络解释了在运动期间与外周动脉低血压相关的慢性上腔静脉综合征的发生。治疗包括上腔静脉经皮腔内球囊血管成形术，随后植入Wallstent支架。该手术纠正了所有导致所报告的应激生理病理限制的血流动力学异常。
