Echocardiography Laboratory, Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA.
Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
Rev Cardiovasc Med. 2019 Jun 30;20(2):99-100. doi: 10.31083/j.rcm.2019.02.510.
A 70-year-old female with severe aortic stenosis presented for aortic valve replacement and underwent routine preoperative Swan-Ganz catheter placement. Transesophageal echocardiography demonstrated a dilated coronary sinus with a catheter present. A high suspicion of venous anomaly prompted an agitated saline study. Flow through the coronary sinus into the right atrium was observed, confirming the presence of a persistent left superior vena cava. Although the persistent left superior vena cava has a low prevalence in the general population, it is one of the most common thoracic venous anomalies. During central venous cannulation, the presence of venous anomalies increases procedural complication rates. Fortunately, our patient remained asymptomatic both before and after catheter insertion. Awareness of this anomaly could help clinicians avoid complications.
一位 70 岁的老年女性因严重的主动脉瓣狭窄就诊，拟行主动脉瓣置换术，并接受了常规术前 Swan-Ganz 导管置管术。经食管超声心动图显示扩张的冠状窦内有导管存在。高度怀疑静脉异常，因此进行了生理盐水激发试验。观察到冠状窦内的血流进入右心房，证实存在永存左上腔静脉。尽管永存左上腔静脉在普通人群中的发病率较低，但它是最常见的胸静脉异常之一。在中心静脉置管过程中，静脉异常会增加操作并发症的发生率。幸运的是，我们的患者在导管插入前后均无症状。了解这种异常可以帮助临床医生避免并发症。
