Muñoz Castellanos Luis, Nivon Magdalena Kuri, Zapata Carreón Rafael R, Salinas Sánchez H Catalina
Instituto Nacional de Cardiología Ignacio Chávez, Departamento de Embriología, INCICH, Juan Badiano No. 1, Col. Sección XVI, Tlalpan 14080 México, D.F.
Arch Cardiol Mex. 2003 Jul-Sep;73(3):175-84.
In order to assess the frequency of persistent left superior vena cava as well as the associated congenital heart disease, 66 hearts were studied from 1277 necropsies of the pathologic collection of the Instituto Nacional de Cardiología "Ignacio Chávez". They were analyzed with the sequential segmental approach. It was determined: atrial situs types and modes of atrioventricular and ventricular arterial connections, morphology of the superior systemic venous return and associated cardiopathies. 33 hearts had situs solitus (group I) and 34 hearts had isomeric situs (Group II) (30 with dextroisomerism and 4 with levoisomerism). The group I showed double superior vena cava, the left one had continuation with the sinus coronary; in 25 of them the left brachiocephalic vein was absent, in 6 this vein was present, 5 with narrow lumen and in one it was dilated (specimen with atresia of the Tebesian valve). The more frequent congenital heart disease were ventricular septal defects, troncoconal cardiopathies and anomalies in the atrioventricular connection. The hearts of group II did not have coronary sinus; the venous connections were in the atrial roof. 19 hearts had double superior vena cava and 15 specimens had only the left one. The congenital heart disease in this group were complex with multiple patterns of association. Left superior vena cava is developed as a consequence of persistence of the continuation of the left anterior and left common cardinal veins with the left horn of sinus venosus when the proximal segment of these veins did not disappear. The left superior vena cava has surgical significance when congenital heart disease is present.
为了评估永存左上腔静脉的发生率以及相关的先天性心脏病，我们对墨西哥国家心脏病研究所“伊格纳西奥·查韦斯”病理科1277例尸检中的66颗心脏进行了研究。采用序列节段分析方法对这些心脏进行分析，确定了心房位置类型、房室和心室动脉连接方式、上腔静脉回流形态以及相关的心脏疾病。33颗心脏为正常心房位置（第一组），34颗心脏为异构心房位置（第二组）（30例为右异构，4例为左异构）。第一组显示有双上腔静脉，左侧上腔静脉与冠状窦延续；其中25例无左头臂静脉，6例有该静脉，5例管腔狭窄，1例扩张（标本为泰贝西瓣闭锁）。较常见的先天性心脏病为室间隔缺损、圆锥干心脏病和房室连接异常。第二组的心脏没有冠状窦；静脉连接位于心房顶部。19颗心脏有双上腔静脉，15例标本只有左侧上腔静脉。该组的先天性心脏病较为复杂，存在多种关联模式。左上腔静脉是由于左前主静脉和左总主静脉与静脉窦左角的延续持续存在，而这些静脉的近端段未消失所致。当存在先天性心脏病时，左上腔静脉具有手术意义。
