Jiang Xuan, Liu Jinduo, Liu Yueheng, Gu Tianxiang
Department of Cardiac Surgery, First Affiliated Hospital, China Medical University, Shenyang, China.
Front Cardiovasc Med. 2022 Apr 5;9:853005. doi: 10.3389/fcvm.2022.853005. eCollection 2022.
We present a case of persistent left superior vena cava (LSVC) draining into the right atrium (RA) the coronary sinus (CS), while the left superior pulmonary vein returns abnormally to the CS. The LSVC may have few clinical consequences but complicates surgical repair of partial anomalous pulmonary venous return (PAPVR). Transthoracic echocardiography and computed tomographic angiography (CTA) showed that a persistent LSVC and PAPVR converged behind the left atrium. During the operation, the left atrium was adjacent to the confluence part. We resected a portion of the adjacent left atrium to create an inlet of the pulmonary veins and used two autologous pericardial patches to reconstruct a tunnel directing flow from the left pulmonary veins to the surgically created inlet in the adjacent left atrium, and another upper tunnel directing flow from the LSVC to the dilated CS. Pulmonary CTA confirmed that both PAPVR flow to LA and LSVC flow to RA were unobstructed. At a 12-month follow-up, the patient was asymptomatic. No supraventricular arrhythmia was detected. We would like to present this additional technique to our armamentarium to treat PAPVR in combination with LSVC.
我们报告一例持续性左上腔静脉（LSVC）引流至右心房（RA）而非冠状窦（CS），同时左上肺静脉异常回流至CS的病例。LSVC可能临床影响较小，但会使部分性肺静脉异位回流（PAPVR）的手术修复变得复杂。经胸超声心动图和计算机断层血管造影（CTA）显示，持续性LSVC和PAPVR在左心房后方汇合。手术过程中，左心房与汇合部位相邻。我们切除了部分相邻的左心房以形成肺静脉入口，并使用两片自体心包补片重建一条将左肺静脉血流引至手术创建的相邻左心房入口的隧道，以及另一条将LSVC血流引至扩张的CS的上方隧道。肺部CTA证实，PAPVR至左心房的血流和LSVC至右心房的血流均无梗阻。在12个月的随访中，患者无症状。未检测到室上性心律失常。我们希望将这种额外的技术纳入我们治疗合并LSVC的PAPVR的方法中。
