Okada T, Yahagi T, Miura T, Araki T, Goto T, Kawashima S, Ozawa T, Saito M, Yokoyama K
Department of Internal Medicine, Yamagata Prefectural Central Hospital.
Kokyu To Junkan. 1993 Mar;41(3):297-301.
A 71-year-old woman presented with recent onset of dyspnea and fatigue on moderate exertion. She had been well during her entire life and had had three pregnancies and deliveries. Cardiomegaly was noted at the age of 30. On physical examination, systolic murmur was detected at the lower left sternal border. The chest X-ray showed cardiomegaly, increased pulmonary vascular markings and elevated right diaphragm. The electrocardiogram showed left ventricular hypertrophy. The echocardiography showed enlargement of right ventricle and atrium, massive tricuspid regurgitation and anomalous venous flow connected to the inferior vena cava from its right-posterior side. Cardiac catheterization demonstrated mild pulmonary hypertension and O2 step-up at the level of the anomalous venous connection to the inferior vena cava. On pulmonary arteriography, left pulmonary venous flow return to the left atrium and atrial septal defect was not found. Veins from the right lung met to form one vessel, went downward, and connected to the inferior vena cava at the level of Th12. L-R shunt was 45% and Qp/Qs was 1.83. Isolated partial anomalous pulmonary venous connection is a rare finding, and it is thought that the natural prognosis is good. The existence of our case, diagnosed at the age of 71, supported this concept.
一名71岁女性因近期出现中度活动时呼吸困难和疲劳前来就诊。她一生身体健康，曾怀孕并分娩三次。30岁时发现心脏扩大。体格检查发现左胸骨下缘有收缩期杂音。胸部X线显示心脏扩大、肺血管纹理增多和右膈抬高。心电图显示左心室肥厚。超声心动图显示右心室和右心房扩大、大量三尖瓣反流以及异常静脉血流从下腔静脉右后侧与其相连。心导管检查显示轻度肺动脉高压，在异常静脉与下腔静脉连接处血氧饱和度升高。肺动脉造影显示左肺静脉血流回左心房，未发现房间隔缺损。右肺静脉汇合形成一支血管，向下走行，在第12胸椎水平与下腔静脉相连。左向右分流为45%，肺循环血流量与体循环血流量之比为1.83。孤立性部分性肺静脉异位连接是一种罕见的发现，一般认为其自然预后良好。我们这例71岁才确诊的病例支持了这一观点。
