Metzler B, Hillebrand H, Eulenbruch H P, Dierkesmann R, Hust M H
Klinik Schillerhöhe, Gerlingen, Germany.
Dtsch Med Wochenschr. 2002 Jan 18;127(3):83-6. doi: 10.1055/s-2002-19592.
Persistent left superior vena cava with right-left shunt into the left atrium.
A 72-year-old patient was admitted to the hospital following bleeding into the basal ganglia secondary to a hypertensive crisis.
The patient was found to suffer from marked hypoxaemia (pO2 49 mmHg) and erythrocytosis (Hb 18,5 g/dl). Subsequent investigations raised suspicion of a right-left shunt. This was verified by a contrast echocardiogram which was performed transthoracically by injection of echo-contrast material from the left. To improve imaging of the shunt a transoesophageal contrast-echocardiogram was carried out. This showed that the persistent left superior vena cava did not, as previously expected, lead directly into the left atrium, but had a connection to the left superior pulmonary vein. This anatomical variant, which so far to our knowledge has not been reported in the literature, could be confirmed by spiral computed tomography. Apart from an atrial septal aneurysm no other cardiac anomaly could be identified.
Ligation of the left superior vena cava could have been a therapeutic option, but the patient declined operative intervention.
In cases of profound hypoxemia and erythrocytosis the differential diagnosis must include a persistent left superior vena cava with anomalous connection to the left atrium. Trans-thoracic and transoesophageal contrast-echocardiography is a simple and reliable method to diagnose persistent left superior vena cava as well as concomitant cardiac anomalies.
永存左上腔静脉伴右向左分流至左心房。
一名72岁患者因高血压危象继发基底节出血入院。
发现该患者存在明显低氧血症（动脉血氧分压49 mmHg）和红细胞增多症（血红蛋白18.5 g/dl）。后续检查怀疑存在右向左分流。经胸从左侧注射超声造影剂进行的对比超声心动图证实了这一点。为更好地显示分流情况，进行了经食管对比超声心动图检查。结果显示，永存左上腔静脉并非如之前预期的那样直接汇入左心房，而是与左上肺静脉相连。据我们所知，这种解剖变异此前在文献中尚未有报道，螺旋计算机断层扫描也证实了这一点。除房间隔瘤外，未发现其他心脏异常。
结扎左上腔静脉本可作为一种治疗选择，但患者拒绝手术干预。
对于严重低氧血症和红细胞增多症患者，鉴别诊断必须考虑永存左上腔静脉伴与左心房异常连接的情况。经胸和经食管对比超声心动图是诊断永存左上腔静脉及合并心脏异常的一种简单可靠的方法。
