Harrison J K, Hearne S E, Baker W A, Van Trigt P, Leidig G, Bashore T M, O'Laughlin M P
Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
Cathet Cardiovasc Diagn. 1996 Aug;38(4):387-92. doi: 10.1002/(SICI)1097-0304(199608)38:4<387::AID-CCD14>3.0.CO;2-C.
A 27-yr-old woman with recurrent episodes of hemoptysis (and hematemesis due to esophageal varices) was found to have unilateral pulmonary vein atresia. Reversed flow in the left pulmonary artery, a finding highly suggestive of this rare congenital anomaly, was demonstrated during cardiac catheterization. The definitive diagnosis was afforded by pulmonary wedge angiography, which not only demonstrated the atretic leftsided pulmonary veins, but also revealed a serpiginous system of systemic collateral veins to be the cause of her esophageal varices. Pneumonectomy of the nonfunctioning hypoplastic lung, the most successful approach to this disorder, may be complicated by severe bleeding of the numerous systemic arterial collateral vessels transected during surgical mobilization of the affected lung. Percutaneously delivered vascular occlusion coils were used in this case to occlude the large systemic to pulmonary artery collateral arteries immediately prior to pneumonectomy. Intra- and perioperative bleeding was minimal, and the patient has done well without further episodes of hemoptysis or hematemesis. Percutaneous occlusion of systemic to pulmonary collaterals may prove useful as a preoperative step for other congenital heart disease patients requiring lung or heart/lung transplantation.
一名27岁女性反复出现咯血（以及因食管静脉曲张导致的呕血），经检查发现患有单侧肺静脉闭锁。心脏导管检查期间显示左肺动脉出现反向血流，这一发现高度提示了这种罕见的先天性异常。肺楔形血管造影术做出了明确诊断，该检查不仅显示了左侧闭锁的肺静脉，还揭示了迂曲的体循环侧支静脉系统是其食管静脉曲张的病因。对无功能的发育不全肺进行肺切除术是治疗该疾病最成功的方法，但在手术游离患肺过程中横断众多体循环动脉侧支血管时，可能会出现严重出血的并发症。在本病例中，肺切除术前即刻使用经皮递送的血管闭塞线圈封堵了粗大的体循环至肺动脉的侧支动脉。术中和围手术期出血极少，患者恢复良好，未再出现咯血或呕血。经皮封堵体循环至肺的侧支血管对于其他需要进行肺或心肺移植的先天性心脏病患者而言，可能是一个有用的术前步骤。
