Yamane Teiichi, Date Taro, Tokuda Michifumi, Aramaki Yasuko, Inada Keiichi, Matsuo Seiichiro, Shibayama Kenri, Miyanaga Satoru, Miyazaki Hidekazu, Sugimoto Ken-ichi, Sakuma Tohru, Fukuda Kunihiko, Mochizuki Seibu, Yoshimura Michihiro
Department of Cardiology, Jikei University School of Medicine, Medical Center, Tokyo, Japan.
Circ J. 2008 Aug;72(8):1285-90. doi: 10.1253/circj.72.1285.
Although the common trunk of left pulmonary veins (PVs) has been reported as a relatively popular anatomical variation of PVs, little is known about the coalescence of contralateral PVs. The present study was conducted to reveal the prevalence and electrophysiologic characteristics of the confluent inferior common PVs.
Anatomical variation in the PV drainage to the left atrium (LA) was assessed using the multidetector computed tomography scan in 326 patients with atrial fibrillation (AF) who underwent the PV isolation procedure. Coalescence of inferior PVs was observed in 5 cases (1.5%). Both inferior PVs conjoined prior to the junction with the LA in 3 cases, while they coalesced at the LA junction in the other 2 cases. The arrhythmogenic activities of the confluent inferior PVs were generally low in all cases without any ectopic firings triggering the observed AF. All inferior PVs, as well as the superior PVs, were successfully isolated either en bloc at the common trunk or individually at the orifice of each PV.
Confluent inferior PVs were present in 1.5% of cases in patients with AF who underwent the PV isolation procedure. Preoperative recognition of this venous anomaly by 3-dimensional imaging is important for smooth and safe ablation.
尽管左肺静脉（PVs）的共同主干已被报道为PVs相对常见的解剖变异，但对侧PVs的融合情况却知之甚少。本研究旨在揭示汇合的下肺静脉共同主干的发生率及电生理特征。
对326例行PV隔离术的房颤（AF）患者，采用多排螺旋CT扫描评估PVs引流至左心房（LA）的解剖变异。观察到5例（1.5%）存在下肺静脉融合。其中3例下肺静脉在与LA汇合前相连，另外2例在与LA汇合处融合。在所有病例中，汇合的下肺静脉的致心律失常活性普遍较低，未观察到任何触发AF的异位激动。所有下肺静脉以及上肺静脉均成功在共同主干处整块隔离或在每个PV的开口处单独隔离。
在接受PV隔离术的AF患者中，1.5%的病例存在汇合的下肺静脉共同主干。术前通过三维成像识别这种静脉异常对于顺利、安全地进行消融很重要。
