Wang Xingming, Zhou Mei, Wang Lei, Han Lei, Li Peng, Nie Fei, Li Zeshu
Department of Thoracic and Cardiovascular Surgery, PKUcare Luzhong Hospital, Zibo, Shandong, China; Doctor of clinical Medicine of Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
Department of Thoracic and Cardiovascular Surgery, PKUcare Luzhong Hospital, Zibo, Shandong, China.
Int J Surg Case Rep. 2022 Jul;96:107384. doi: 10.1016/j.ijscr.2022.107384. Epub 2022 Jul 2.
Systemic venous anomaly is less common clinically, and ectopic connection of inferior vena cava is less common clinically than ectopic connection of superior vena cava. When the inferior vena cava is abnormally connected to the left atrium, a low atrial septal defect can be combined. It is difficult to make preoperative diagnosis of this kind of disease clinically. Blind occlusion of the ASD (atrial septal defect) will cause the iatrogenic inferior vena cava flowing back to the left atrium completely or partially. Conventional median thoracotomy for repair of such an atrial septal defect should be performed with more caution. It has been reported that after repair of an atrial septal defect, the inferior vena cava was mistakenly separated into the left atrium. Therefore, we suggest that preoperative evaluation of inferior atrial septal defect should be with more cautious. When transthoracic echocardiography (TTE) cannot fully explain the clinical symptoms, Ultrasound contrast may be considered. During the repair of the inferior vena cava ASD, it is not only necessary to find the location of Euclidean valve, but also to accurately explore the inferior vena cava opening so as to avoid the iatrogenic inferior vena cava being separated into the left atrium.
体静脉异常在临床上较为少见,而下腔静脉异位连接在临床上比上腔静脉异位连接更为少见。当下腔静脉异常连接至左心房时,可合并低位房间隔缺损。临床上对这类疾病进行术前诊断较为困难。盲目封堵房间隔缺损会导致医源性下腔静脉完全或部分回流至左心房。对于此类房间隔缺损的修复,传统正中开胸手术应更加谨慎。据报道,在房间隔缺损修复术后,下腔静脉被误分入左心房。因此,我们建议对低位房间隔缺损的术前评估应更加谨慎。当经胸超声心动图(TTE)不能完全解释临床症状时,可考虑超声造影。在下腔静脉房间隔缺损修复术中,不仅要找到欧氏瓣的位置,还要准确探查下腔静脉开口,以避免医源性下腔静脉被分入左心房。