体静脉连接异常的心血管造影诊断

目的评价心血管造影对体静脉连接异常的诊断价值。方法回顾分析371例经手术证实的体静脉连接异常患儿的心血管造影。结果左上腔静脉残存共190例,其中左上腔静脉回流入冠状窦171例,左上腔静脉回流入左房9例,左上腔静脉经无顶冠状窦回流入左房10例;右上腔静脉缺如3例;下腔静脉异常连接42例,其中40例为下腔静脉中断伴奇静脉回流,1例为下腔静脉回流入左房,1例为双下腔静脉。无名静脉异常共136例。结论体静脉连接异常在先天性心脏病的患者中并不少见,先心病术前通过心血管造影了解体静脉的连接关系对手术有重要的指导意义。     

双源CT对先天性心脏病纵隔静脉异常的诊断

目的 探讨双源CT(DSCT)心血管成像对先天性心脏病(先心病)纵隔静脉异常的诊断价值.资料与方法 搜集存在纵隔静脉异常的先心病患者62例,男39例,女23例,年龄17天～29岁.使用Siemens双源CT扫描机扫描,运用多种图像后处理方法,重点观察上腔静脉、头臂静脉、奇静脉、半奇静脉、肺静脉及冠状静脉等有无异常.结果 62例中共存在纵隔静脉异常63处(其中1例同时合并永存左上腔静脉和半奇静脉异常),DSCT均正确诊断,可分为6类:永存左上腔静脉29处,24处经冠状静脉窦汇入右心房,4处直接汇入左心房,1处双上腔静脉分别汇入单心房;左头臂静脉异常15处,包括:主动脉弓下左头臂静脉12处、无名动脉后左头臂静脉1处、食管后左头臂静脉1处、左头臂静脉分为上下2支1处;肺静脉畸形引流15处,包括完全型11处和部分型4处;肺静脉曲张1处,为室问隔缺损并肺动脉高压患儿;无顶冠状静脉窦2处,均为法洛四联症患者;下腔静脉中断并半奇静脉扩张、异常引流入永存左上腔静脉1处.结论 DSCT在先心病纵隔静脉异常的诊断及术前评估中具有重要的应用价值.     

多层螺旋CT诊断永存左上腔静脉伴右上腔静脉缺如一例

患者男,61岁,因咳嗽1周,于2011年4月来我院就诊.既往无心脏病史.体检未见异常.为明确有无肺部感染而行胸部MSCT检查.CT定位像显示右上纵隔空虚(图1),轴面像显示右侧上腔静脉缺如,主动脉弓和左肺动脉左侧见上下连续的椭圆形软组织密度结节影,边界清晰光整,考虑永存左上腔静脉畸形,遂做增强扫描进一步确诊.应用碘海醇(320 mg I/ml )80 ml以3.O ml/s流率经右侧肘前静脉注射,注药开始15 s后启动CT扫描,于轴面像证实右侧上腔静脉缺如,明显强化的右锁骨下静脉和右颈静脉汇合后经胸骨后间隙横行至左侧,与左侧头臂静脉汇合形成左上腔静脉(图2),沿主动脉弓和左肺动脉左侧下行,中途接受奇静脉血流,然后继续向下向后绕行于左心房和左心室之间的冠状沟,最后经扩大的冠状静脉窦汇入右心房(图3).     

主动脉弓左侧先天性静脉异常的CT鉴别诊断

目的：分析41例主动脉弓左侧先天性静脉变异的CT表及鉴别诊断。方法：所有患者均有CT平扫,其中3例行增强扫描,5例另做MRI或超声检查确诊,6例做最大信号强度投影和表面遮盖法三维重建。结果：永存在上腔静脉24例,其中双上腔静脉23例,永存左上腔静脉并右上腔静脉缺如1例,异常左头臂静脉11例,其中6例合并主动脉畸形;左上叶的部分异常肺静脉引流4例,其中1例并双上腔静脉畸形;左头臂静脉与奇静脉异常连接2例,它们的共同表现是在主动态弓可见圆形或类圆形结影,但它们具有各自不同的血管行程,可加以区别。结论：熟悉这些少见的先天性异常有助于避免误诊,高质量的DT增强扫描这些先天性异常的诊断及鉴别诊断有重要价值。     

超声心动图检出飞行员先天性心脏病的医学鉴定价值

目的 探讨超声心动图检出现役飞行员先天性心脏病对招飞体检工作的意义. 方法 回顾性分析9年间在我院超声科行超声心动图检查的现役飞行员中,因行超声心动图检查首次诊断为先天性心脏病的患者的影像学资料. 结果 发现先天性心脏病患者10例,其中主动脉瓣畸形4例,均为二瓣畸形;房间隔缺损3例,均为继发孔型房间隔缺损;冠状动脉瘘1例;永存左上腔静脉伴冠状静脉窦扩张2例.10例患先天性心脏病的飞行员9例飞行结论 为飞行不合格,1例飞行结论 为暂时飞行不合格. 结论 超声心动图检查在诊断现役飞行员先天性心脏病的过程中具有准确、安全、快捷的特点,是明确诊断的首选方法.因此,如条件允许,超声心动图应列为招飞体检的常规检查项目.     

胎儿永存左上腔静脉和相关先天异常的产前MRI诊断

目的:探讨胎儿永存左上腔静脉和相关畸形的产前MRI表现及MRI诊断价值.方法:12例孕妇,孕龄21～35周.产前常规行超声检查后24～48 h内行MR检查,采用快速平衡稳态采集(FIESTA)序列或平衡稳态梯度回波(B-FFE)序列、单次激发快速自旋回波(SSFSE)序列和非门控动态FIESTA电影序列或实时B-FFE序列,行胎儿颅脑胸腹部常规及胸部重点冠状面、矢状面及横断面扫描、心脏长短轴扫描,将产前MRI、US表现与出生后影像表现、手术或尸解结果对照.结果:12例永存左上腔静脉全部为双侧上腔静脉,其中l例存在桥静脉.在合并相关异常方面其中10例合并心脏畸形、1例合并羊水过少、1例无合并异常.10例合并心脏畸形中4例合并心外异常.对于永存左上腔静脉产前MRI全部准确诊断,产前US准确诊断5例、漏诊7例.对于合并10例心脏畸形,产前MRI准确诊断7例、误诊1例、漏诊2例;产前US准确诊断7例、误诊2例、漏诊1例.结论:产前MRI能准确诊断永存左上腔静脉,对其合并的相关心内异常诊断准确性不如产前超声,对合并的心外异常诊断准确性优于超声.     

非体外循环下全腔静脉-肺动脉连接术治疗复杂先天性心脏病16例分析

目的总结非体外循环下全腔静脉-肺动脉连接术（TCPC）治疗复杂先天性心脏病的临床经验。方法回顾性分析我院2006～2010年接受TCPC的16例复杂先天性心脏畸形患者,包括三尖瓣闭锁9例（其中1例为双向Glenn术后5年）,完全性大动脉转位合并房窒间隔缺损、肺动脉瓣狭窄4例,右室双出口伴其他畸形2例,单心室1例,均采用非体外循环下手术。结果术后无1例死亡,均痊愈出院,3例术后出现大量胸腔积液,经积极处理后恢复。所有患者症状消失,无明显发绀．经皮血氧饱和度达到89％～97％。恢复良好。结论TCPC方法简便易行,在严格掌握手术适应证、手术技巧及加强术后并发症防治的情况下,TCPC治疗复杂型先天性心脏病可取得良好的手术效果。     

产前超声对胎儿永存左上腔静脉的诊断及鉴别诊断

目的探讨产前超声检查在诊断胎儿永存左上腔静脉(PLSVC)中的诊断价值。方法回顾分析24例经我院诊断最后确诊的永存左上腔静脉胎儿的超声图像,总结不同类型的胎儿永存左上腔静脉的超声特点。结果 23例永存左上腔静脉胎儿在出生后经新生儿心脏超声证实。其中10例合并内脏反位,6例单纯PLSVC,10例合并其他畸形(包括1例合并完全性心内膜垫缺损,1例左室发育不全,1例二尖瓣闭锁,2例右位主动脉弓,2例室间隔缺损,1例合并Dandy-Walker畸形,1例肾积水,1例单脐动脉)。漏诊1例。结论产前超声检查对诊断胎儿永存左上腔静脉具有重要的价值,是首选的检查方法。     

先天性下腔静脉畸形的MSCT诊断(附24例报告)

目的 探讨先天性下腔静脉畸形的MSCT影像学表现，评价MSCT诊断价值。方法 选取并分析经MSCT证实的24例先天性下腔静脉畸形患者的影像学表现及临床意义。结果 24例先天性下腔静脉畸形包括下腔静脉肝段缺如4例，其中2例伴有奇静脉代偿引流至上腔静脉，肝静脉直接回流右心房；2例为单纯性。左肾静脉畸形10例，CT横断面显示腹主动脉后左肾静脉、左肾静脉环绕腹主动脉分别为9例、1例。双下腔静脉8例，CT表现为肾下段腹主动脉左右两侧上行的下腔静脉。下腔静脉后输尿管2例。11例患者检出镜下血尿，4例有高血压病史，1例患者为多脾综合征，2例合并肾脏血管平滑肌脂肪瘤，其余患者为偶然发现。结论 MSCT能清晰显示下腔静脉及属支的畸形，是诊断先天性下腔静脉畸形的重要方法，可降低手术及介入诊治中的风险，为临床诊治提供重要参考依据。     

经皮上腔静脉成型术治疗上腔静脉阻塞综合征

目的　探讨经皮上腔静脉支架成型术治疗上腔静脉阻塞综合征的方法及临床价值。方法　上腔静脉阻塞综合征患者 1 5例 ,包括肺癌伴纵隔淋巴结转移 1 0例 ,非霍奇金淋巴瘤 3例 ,食管癌伴纵隔淋巴结转移 2例 ,均先行右锁骨下静脉或肘静脉穿刺插管至阻塞上段作造影、测压 ,显示阻塞的部位、程度、侧支循环及有无血栓等情况 ,再经右侧股静脉穿刺入路置放上腔静脉支架。结果　 1 5例患者均 1次成功地植入上腔静脉支架 ,1例患者因狭窄范围超过 1 0cm而导入 2枚支架 ,其余均置入 1枚支架。术后造影显示血流恢复通畅 ,手术前后梗阻远端测压从术前的 (30 .5± 2 .3)cmH2 O降到术后的 (8.8±1 .5 )cmH2 O(均为卧位测压 ) ,差异有显著性 (P <0 .0 1 )。术后造影侧支静脉不再显影 ,上腔静脉阻塞症状明显改善 ,随访 6个月 ,除 1例患者因合并血栓经局部溶栓、球囊扩张治疗后症状改善 ,其余患者均无阻塞症状复发。结论　经皮上腔静脉成型术创伤小、恢复快、疗效确切 ,是治疗上腔静脉阻塞综合征的有效方法。     

Congenital left superior vena cava with absent right superior vena cava: a cause of progressive mediastinal widening

We wish to report a patient with the rare anomaly of congenital left superior vena cava and absent right superior vena cava. This became apparent on chest radiographs by the development of a left mediastinal "mass" over a one-year period. The role of contrast-enhanced computed tomographic scanning in the detection of venous anomalies is stressed.     

Unusual variant of left superior vena cava

The first computed tomography-documented case of a persistent left superior vena cava that drains directly into the right superior vena cava is presented. The venous embryology is reviewed and the differential diagnosis of other pertinent venous anomalies is discussed. The patient also had an incidental finding of a congenitally absent left lobe of the thyroid gland.     

Hemiazygos continuation of a left inferior vena cava draining into the right atrium via persistent left superior vena cava: Demonstration by helical computed tomography

We report an unusual case of hemiazygos continuation of a left inferior vena cava draining into the right atrium via the persistent superior vena cava. Spiral computed tomography (CT) showed the course and the flow direction of this vena caval anomaly in a real-time manner, obviating conventional venography.     

Inferior vena cava filter from left-sided superior vena cava

We describe the unusual case of a 71-year-old male with a history of deep vein thrombosis and recurrent multiple pulmonary embolism (PE) despite adequate anticoagulation. Computed tomography (CT) and brachiocephalic venography revealed a left-sided superior vena cava. We describe successful placement of an inferior vena cava filter via a left-sided superior vena cava.     

Persistent left superior vena cava to left atrial communication detected with radionuclide angiography: a case report

A persistent left superior vena cava (PLSVC) is the common clinical congenital abnormality of the greater central veins. This anomaly may occur as an isolated lesion, but rarely it is significantly associated with other congenital cardiac lesions, particularly it drain into the left atrium. We recently encountered a patient in whom PLSVC to left atrial communication with atrial septal defect was diagnosed on the basis of radionuclide angiography with Tc-99m pertechnetate. Radionuclide angiography might be the noninvasive study of choice in patients suspected of having PLSVC by the clinical findings or chest roentgenography.     

Persistent left superior vena cava detected with radionuclide angiocardiography

A 28-year-old man presented with paresthesias, fatigue, central cyanosis, and erythrocytosis. A first pass flow study with Tc-99m as free pertechnetate was done, among other tests, to exclude a central shunt when a persistent left superior vena cava was incidentally detected. The value of radionuclide angiocardiography to examine the central circulation noninvasively was again illustrated in this case.     

Shunt between right subclavian vein and the left heart in superior vena cava obstruction due to lung cancer

A case in which there was a shunt between systemic veins and the left heart in superior vena cava syndrome due to lung cancer is reported. Superior vena cava syndrome developed one and a half years after right upper lobectomy with combined resection of thoracic wall. Radionuclide venography from the right antecubital vein showed immediate visualization of the left ventricle and aorta, before the right atrium and right ventricle were seen. In the superior vena cava syndrome due to a malignant tumor, this rare pathway as well as usual collaterals should be considered.     

Right-to-left shunting via persistent left superior vena cava identified by perfusion lung scintigraphy

A right-to-left shunt was demonstrated following a left antecubital injection of [99mTc]MAA but was not seen after a right antecubital injection. This was because of the presence of a persistent left superior vena cava draining into the left atrium. Recognition of the presence of this anatomic variant is of importance in perfusion imaging, in patients with otherwise unexplained systemic embolization.     

Duplication of the superior vena cava: detection by radionuclide angiography

The authors report three cases of duplication of the superior vena cava which were demonstrated by radionuclide angiography. Nuclear imaging was performed in order to demonstrate a left-to-right intracardiac shunt. Injection into the left external jugular vein demonstrated the presence of a duplication of the superior vena cava in addition to the presence of a shunt.     

Duplication of the superior vena cava: Detection by radionuclide angiography

The authors report three cases of duplication of the superior vena cava which were demonstrated by radionuclide angiography. Nuclear imaging was performed in order to demonstrate a left-to-right intracardiac shunt. Injection into the left external jugular vein demonstrated the presence of a duplication of the superior vena cava in addition to the presence of a shunt.