两例经股静脉插入的导管误入肝静脉，可能归因于欧氏瓣：病例报告
Two cases of catheters inserted from the femoral vein straying into the hepatic vein, possibly owing to a Eustachian valve: a case report.
作者信息
Takise Yoshiaki, Maeda Takuma, Yonezawa Hiroki, Minami Kimito, Morinaga Masahiro, Ohnishi Yoshihiko
机构信息
Department of Anesthesiology, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi Suita, Osaka, 564-8565, Japan.
出版信息
JA Clin Rep. 2022 Jul 23;8(1):54. doi: 10.1186/s40981-022-00544-1.
BACKGROUND
In minimally invasive cardiac surgery (MICS) and extracorporeal membrane oxygenation (ECMO), a guidewire is inserted from the femoral vein (FV) into the right atrium. However, rarely, the guidewire or catheter strays into the hepatic vein (HV) because of the inferior vena cava (IVC)-HV angle. We report two cases in which a guidewire and venous cannula from the FV strayed into the HV, likely owing to a Eustachian valve.
CASE PRESENTATION
Both patients were women who underwent transesophageal echocardiography-guided FV cannulation. In case 1, a guidewire from the FV strayed into the HV owing to a Eustachian valve. In case 2, ECMO was established postoperatively. Transthoracic echocardiography confirmed the venous cannula had strayed into the HV. Computed tomography indicated IVC-HC angles of 129° (case 1) and 102° (case 2).
CONCLUSION
A Eustachian valve can impede devices inserted from the FV and even allow them to stray into the HV.
背景
在微创心脏手术（MICS）和体外膜肺氧合（ECMO）中，导丝从股静脉（FV）插入右心房。然而，由于下腔静脉（IVC）与肝静脉（HV）的夹角，导丝或导管误入肝静脉的情况极为罕见。我们报告了两例因欧氏瓣导致股静脉的导丝和静脉插管误入肝静脉的病例。
病例介绍
两名患者均为女性，接受了经食管超声心动图引导下的股静脉插管。病例1中，由于欧氏瓣，股静脉的导丝误入肝静脉。病例2中，术后建立了体外膜肺氧合。经胸超声心动图证实静脉插管误入肝静脉。计算机断层扫描显示下腔静脉与肝静脉夹角分别为129°（病例1）和102°（病例2）。
结论
欧氏瓣可阻碍从股静脉插入的器械，甚至使其误入肝静脉。
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