Kisanuki F, Miyahara K, Sonoda M, Miyanohara H, Kukihara T, Amitani S, Nakamura K, Arima T
Cardiovascular Division, Shinkyo Hospital.
Kokyu To Junkan. 1992 May;40(5):511-6.
We presented a rare case of isolated tricuspid regurgitation (TR) associated with persistent left superior vena cava (PLSVC). A 69-year old female was admitted to our hospital because of arrhythmia and cardiomegaly. Pansystolic cardiac murmur of Levine 2/6 was heard in her Erb's area. Remarkable cardiomegaly was revealed as 78% of cardiothoracic ratio and electrocardiographic findings showed atrial fibrillation. Echocardiographically, obvious dilatation of coronary sinus, right atrium and right ventricle were recognized and left atrium was also dilated moderately. Although results of right cardiac catheterization showed almost normal pressure, remarkable TR of grade IV was registered by Doppler echocardiography. Additional diagnosis of PLSVC drained to dilated coronary sinus was made by venography from the left antecubital vein. But evidence of other cardiac shunt diseases and other abnormalities which might be a cause of TR was negligible. It is reported, in general, that PLSVC drained to coronary sinus occurs asymptomatically, and there is no accepted theory that PLSVC is able to be a cause of TR alone. So, we diagnosed our case as rare isolated TR associated with PLSVC, and because only two such cases are reported in Japanese, we reported it.
我们报告了一例罕见的孤立性三尖瓣反流（TR）合并永存左上腔静脉（PLSVC）的病例。一名69岁女性因心律失常和心脏肿大入住我院。在其Erb区可闻及Levine 2/6级全收缩期心脏杂音。心脏X线检查显示心胸比率为78%，提示明显心脏肿大，心电图检查结果显示心房颤动。超声心动图检查发现冠状窦、右心房和右心室明显扩张，左心房也有中度扩张。尽管右心导管检查结果显示压力几乎正常，但多普勒超声心动图显示有显著的IV级TR。通过左肘前静脉造影进一步诊断为PLSVC引流至扩张的冠状窦。但其他可能导致TR的心脏分流疾病和其他异常的证据可忽略不计。一般报道称，PLSVC引流至冠状窦通常无症状，目前尚无公认的理论认为PLSVC可单独成为TR的病因。因此，我们将该病例诊断为与PLSVC相关的罕见孤立性TR，由于在日本仅报道过两例此类病例，故予以报告。
