Department of Surgery, Section of Cardiac and Thoracic Surgery, Center for Aortic Diseases, The University of Chicago Medicine, 5841 S Maryland Avenue, MC5040, Chicago, IL, 60637, USA.
Gen Thorac Cardiovasc Surg. 2021 Apr;69(4):673-678. doi: 10.1007/s11748-020-01505-0. Epub 2020 Oct 10.
We present a surgical technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus with orthotopic heart transplantation.
Between January 2013 and July 2019, a total of 224 patients underwent orthotopic heart transplantation in our institution. Among them, three patients (3/224, 1.3%) had a persistent left superior vena cava draining into the coronary sinus. The persistent left superior vena cava and the coronary sinus was isolated and fully mobilized as an en bloc conduit at the time of explanting the heart. After the standard anastomoses using the bicaval technique, the conduit was routed anterior to the great vessels and anastomosed to the right atrial appendage. A smooth venous drainage into the right atrium from the rerouted persistent left superior vena cava was intraoperatively confirmed by transesophageal echocardiography.
The postoperative course was uneventful in all patients. There were no major postoperative complication and in-hospital mortality. The routed persistent left superior vena cava-coronary sinus conduits were confirmed to be patent without stenosis/obstruction by an enhanced computed tomography. Cardiac biopsies through the reconstructed persistent left superior vena cava were possible without any difficulty.
The anterior rerouting technique for a reconstruction of a persistent left superior vena cava draining into the coronary sinus in an orthotopic heart transplantation was feasible and reproducible.
我们介绍了一种用于重建左永存上腔静脉（引流至冠状窦）的手术技术，应用于原位心脏移植。
2013 年 1 月至 2019 年 7 月，我们机构共进行了 224 例原位心脏移植。其中，3 例（3/224，1.3%）患者存在左永存上腔静脉引流至冠状窦。在心脏取出时，将永存的左上腔静脉和冠状窦完全游离并作为一个整体管道进行隔离。在使用双腔静脉技术进行标准吻合后，将管道置于大血管前方并吻合至右心耳。通过经食管超声心动图，术中确认重新定位的左永存上腔静脉从管道顺畅地引流至右心房。
所有患者的术后过程均顺利，无重大术后并发症和院内死亡。增强计算机断层扫描证实，经重建的左永存上腔静脉-冠状窦管道通畅，无狭窄/阻塞。通过重建的左永存上腔静脉进行心脏活检是可能的，没有任何困难。
在原位心脏移植中，将引流至冠状窦的左永存上腔静脉进行前侧重建是可行且可重复的。
