Abrams Benjamin, Hoffman Jordan, Aftab Muhammad, Evers Jacob, Seres Tamas
University of Colorado, Aurora, CO, USA.
Semin Cardiothorac Vasc Anesth. 2019 Dec;23(4):418-421. doi: 10.1177/1089253219832608. Epub 2019 Feb 27.
Stenosis at either the superior or inferior caval anastomosis is a rare complication of orthotopic heart transplantation (OHT) and is unique to the bicaval surgical technique. The severity of stenosis dictates the degree of clinical significance, varying from asymptomatic to congestive end-organ injury and hemodynamic instability from impaired preload. Due to differences in the anatomic location of organ congestion, the clinical presentation also depends on which of the 2 anastomoses is involved. In this article, the authors describe a case of stenosis at the inferior vena cava to right atrium anastomosis, which was diagnosed intraoperatively during OHT after weaning from cardiopulmonary bypass. Transesophageal echocardiography provided an accurate and timely diagnosis of this complication, which allowed for immediate surgical correction. Surprisingly, a large, native Eustachian valve was found to be obstructing the anastomosis. Resection of the valve relieved the previously significant narrowing across the anastomosis. This case highlights the importance of thorough intraoperative transesophageal echocardiographic evaluation of graft anastomoses during OHT, as well as an understanding on the part of the echocardiographer of the specific surgical techniques employed during OHT.
上腔或下腔静脉吻合口狭窄是原位心脏移植（OHT）的一种罕见并发症，且是双腔静脉手术技术所特有的。狭窄的严重程度决定了临床意义的程度，从无症状到充血性终末器官损伤以及因前负荷受损导致的血流动力学不稳定不等。由于器官充血的解剖位置不同，临床表现也取决于涉及的是两个吻合口中的哪一个。在本文中，作者描述了一例下腔静脉至右心房吻合口狭窄的病例，该病例在心肺转流脱机后的OHT术中被诊断出来。经食管超声心动图对这一并发症进行了准确及时的诊断，从而得以立即进行手术矫正。令人惊讶的是，发现一个巨大的、天然的欧氏瓣阻塞了吻合口。切除该瓣膜缓解了吻合口先前的明显狭窄。本病例强调了在OHT期间对移植吻合口进行全面术中经食管超声心动图评估的重要性，以及超声心动图检查人员对OHT期间所采用的特定手术技术的了解。
