Gamet Alexandre, Raud-Raynier Pascale, Kerforne Thomas, Velasco Stéphane, Christiaens Luc
Department of Cardiology, University Hospital of Poitiers, Poitiers, France.
Cardiothoracic Intensive Care Unit, University Hospital of Poitiers, Poitiers, France.
J Cardiovasc Echogr. 2017 Jul-Sep;27(3):104-106. doi: 10.4103/jcecho.jcecho_42_16.
Cardiac shunts are often described in congenital or pediatric populations, but systemic-to-pulmonary venous shunts in adult patients are reported in literature in isolated case reports. We present the case of a 70-year-old female with a left superior vena cava (SVC) draining into the left atrium by the left superior pulmonary vein, with a complete right-to-left shunt of the superior venous circulation caused by a former catheter thrombosis in the right SVC. Diagnosis was suspected after a contrast echocardiography showing an exclusive perfusion of left heart after intravenous injection and confirmed by helical computed tomography with three-dimensional reconstruction. After medico-surgical discussion, a first-line conservative treatment with oxygen therapy was chosen, due to the stability of symptoms and high predicted risk of perioperative mortality. The particularities of this case are that we cannot determine if the origin of this shunt is a latent persistent left SVC becoming symptomatic after the SVC obstruction or an abnormal collateral pathway due to the thrombosis and the unusual indirect communication through a pulmonary vein.
心脏分流常出现在先天性或儿科人群中，但成人体系统性至肺静脉分流仅在孤立的病例报告中有文献记载。我们报告了一例70岁女性病例，其左上腔静脉（SVC）通过左上肺静脉引流至左心房，因既往右SVC导管血栓形成导致上腔静脉循环完全右向左分流。静脉注射造影剂后经超声心动图检查显示仅左心灌注，怀疑有此诊断，后经螺旋计算机断层扫描三维重建得以证实。在内科和外科会诊后，鉴于症状稳定且围手术期死亡预测风险高，选择了氧疗作为一线保守治疗。该病例的特殊之处在于，我们无法确定此分流的起源是潜在的持续左上腔静脉在SVC梗阻后出现症状，还是由于血栓形成导致的异常侧支通路以及通过肺静脉的异常间接交通。
