Kougias Panagiotis, Peden Eric K, Lin Peter, Buergler John, Lumsden Alan B
Michael E. DeBakey Department of Surgery, Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, TX 77030, USA.
J Vasc Surg. 2006 Oct;44(4):875-8. doi: 10.1016/j.jvs.2006.06.022.
Left-sided superior vena cava (SVC) as the result of persistence of the left superior cardinal vein in postnatal life is a rare congenital anomaly, is usually associated with other cardiac defects, and can cause symptoms of right to left shunt. We report the case of a 58-year-old Asian man with a history of end-stage renal disease and Ebstein anomaly that was corrected surgically who presented with progressively worsening disabling dyspnea. An echocardiogram with concomitant intravenous saline injection raised the suspicion of right to left shunt, a finding that was confirmed with contrast injection of the left SVC that rapidly filled the left heart chambers and subsequently the aortic arch. To treat this anomaly, we accessed the left basilic vein under ultrasound guidance and inserted a 14F sheath into the left subclavian vein. A covered stent was then prepared at the back table with three Prolene 4-0 sutures that were wrapped around the middle portion of the graft to achieve a controlled area of stenosis after deployment. The stent graft was placed along the proximal innominate vein and the contiguous part of the left SVC. Coil embolization was then performed with coils that were positioned at the stenotic area of the covered stent. An immediate venogram demonstrated residual flow into the left SVC; however, a delayed venogram 2 weeks after the procedure showed occlusion of the left SVC and the development of collaterals to the right innominate vein that was draining to a normal right SVC. The patient remained marginally hypotensive after surgery, but he soon noted a substantial improvement in his symptoms. A repeat echocardiogram with intravenous saline injection confirmed the correction of the right to left shunt. Endovascular repair of persistent left SVC is feasible and safe and can be performed with minimal morbidity.
左侧上腔静脉（SVC）是由于出生后左上主静脉持续存在导致的一种罕见先天性异常，通常与其他心脏缺陷相关，并可引起右向左分流症状。我们报告一例58岁亚洲男性病例，该患者有终末期肾病病史且曾接受过Ebstein畸形手术矫正，现出现进行性加重的致残性呼吸困难。经胸超声心动图检查并同时静脉注射生理盐水后怀疑存在右向左分流，经左SVC造影剂注射证实了这一发现，造影剂迅速充盈左心腔并随后进入主动脉弓。为治疗这一异常，我们在超声引导下穿刺左侧贵要静脉并将一根14F鞘管插入左锁骨下静脉。然后在手术台上用三根4-0普理灵缝线包裹移植物中部制备一个覆膜支架，以便在释放后形成可控的狭窄区域。将支架移植物沿无名静脉近端和左SVC的相邻部分放置。然后用线圈在覆膜支架的狭窄区域进行线圈栓塞。即刻静脉造影显示仍有血流进入左SVC；然而，术后2周的延迟静脉造影显示左SVC闭塞，且出现了至右无名静脉的侧支循环，该侧支循环引流至正常的右SVC。患者术后仍有轻度低血压，但他很快注意到症状有显著改善。再次经胸超声心动图检查并静脉注射生理盐水证实右向左分流已得到纠正。持续性左SVC的血管腔内修复是可行且安全的，并且可以以最小的发病率进行。
