Kudo Masafumi, Tsubota Hideki, Akaguma Yuki, Honda Masanori, Okabayashi Hitoshi
Department of Cardiovascular Surgery, Mitsubishi Kyoto Hospital, 1 Katsuragosho-cho, Nishikyo-ku, Kyoto 615-8087, Japan.
J Surg Case Rep. 2025 Sep 3;2025(9):rjaf689. doi: 10.1093/jscr/rjaf689. eCollection 2025 Sep.
Aberrant left brachiocephalic vein (ALBCV), in which the vein passes posterior to the ascending aorta, is a rare vascular anomaly in adults without congenital heart disease. This condition can complicate venous cannulation during cardiac surgery. We report the case of a 78-year-old woman with severe mitral and tricuspid regurgitation. Preoperative imaging revealed an ALBCV joining the superior vena cava near the right atrium. Although the ALBCV was exposed from both sides of the ascending aorta and prepared for potential cannulation, the cardiopulmonary bypass flow rate was maintained using standard bicaval cannulation. Mitral valve replacement, tricuspid annuloplasty, left atrial Maze, and left appendage resection were performed without any complications. Although ALBCV may present challenges during surgery, thorough preoperative recognition and surgical planning allows for successful management. This case underscores the importance of identifying vascular anomalies, such as ALBCV, before cardiac surgery to avoid unexpected complications and ensure optimal outcomes.
异常左头臂静脉（ALBCV），即静脉走行于升主动脉后方，在无先天性心脏病的成年人中是一种罕见的血管异常。这种情况会使心脏手术期间的静脉插管复杂化。我们报告一例78岁患有严重二尖瓣和三尖瓣反流的女性病例。术前影像学检查显示一条异常左头臂静脉在右心房附近汇入上腔静脉。尽管从升主动脉两侧暴露了异常左头臂静脉并为可能的插管做了准备，但使用标准双腔静脉插管维持了体外循环流量。进行了二尖瓣置换术、三尖瓣成形术、左心房迷宫手术和左心耳切除术，无任何并发症。尽管异常左头臂静脉在手术期间可能带来挑战，但术前的充分识别和手术规划可实现成功管理。该病例强调了在心脏手术前识别血管异常（如异常左头臂静脉）的重要性，以避免意外并发症并确保最佳预后。
