原位心脏移植并重建永存左上腔静脉。
Orthotopic heart transplantation with reconstruction of persistent left superior vena cava.
作者信息
Handa Kazuma, Hata Hiroki, Toda Koichi, Miyagawa Shigeru, Yoshikawa Yasushi, Yoshioka Daisuke, Sawa Yoshiki
机构信息
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
出版信息
Surg Case Rep. 2020 Apr 15;6(1):71. doi: 10.1186/s40792-020-00834-9.
BACKGROUND
Persistent left superior vena cava is a not uncommon congenital vascular abnormality. We report a case of heart transplantation with reconstruction of persistent left superior vena cava using a prosthetic vascular graft.
CASE PRESENTATION
A 20-year-old man with idiopathic dilated cardiomyopathy and persistent left superior vena cava underwent orthotopic heart transplantation 2 years and 3 months after left ventricular assist device implantation. Because the persistent left superior vena cava had a larger diameter than the right superior vena cava, the transected persistent left superior vena cava was reconstructed with a prosthetic vascular graft anastomosed to the free wall of the right atrium. Postoperative enhanced computed tomography revealed good patency of the graft. The patient's postoperative course has been uneventful during 2 years of follow-up, despite the risk of complications.
CONCLUSIONS
Reconstruction of a persistent left superior vena cava with a prosthetic vascular graft may be one option at the time of heart transplantation.
背景
永存左上腔静脉是一种并不罕见的先天性血管异常。我们报告一例心脏移植病例，术中使用人工血管移植物重建永存左上腔静脉。
病例介绍
一名20岁患有特发性扩张型心肌病和永存左上腔静脉的男性患者，在植入左心室辅助装置2年零3个月后接受了原位心脏移植。由于永存左上腔静脉的直径大于右上腔静脉，将横断的永存左上腔静脉用人工血管移植物进行重建，并吻合至右心房游离壁。术后增强计算机断层扫描显示移植物通畅良好。尽管存在并发症风险，但在2年的随访期间，患者术后病程平稳。
结论
在心脏移植时，使用人工血管移植物重建永存左上腔静脉可能是一种选择。
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