永存左上腔患者起搏导线植入路径探讨:附28例分析

正永存左上腔静脉(persistent left superior vena cava,PLSVC)在正常人群中发病率为0.3%~0.5%,其中约12%的人群合并其他心血管异常[1-2]。最常见PLSVC为PLSVC直接流入冠状静脉窦,开口于右房,占PLSVC的80%~92%[1,3]。文献对PLSVC有多种分型报道[1,4-5]。但根据PLSVC流入心脏部位的不同,常见的为4种类型:Ⅰ型PLSVC流入冠状静脉窦,右上腔静脉缺如;Ⅱ型PLSVC左右上腔静脉均存在,两者之间不存在交通支;Ⅲ型PLSVC左     

为左上腔静脉永存合并右上腔静脉缺如患者植入起搏导线

目的 对左上腔静脉永存合并右上腔静脉缺如患者的心室起搏导线植入方法作初步探讨,方法 为3例病态窦房结综合征,2例三度房室阻滞患者植入VVI起搏系统,导线经左上腔静脉、冠状静脉窦、右心房、三尖瓣口而固定于右心室心尖部（4例）或至心大静脉远段（1例）,靠近心外膜左缘。结果 5例患者的导线均成功放置分别随访3个月-7年,起搏功能良好。结论 对左上腔静脉存伴右上腔静脉缺如患者植入心脏起搏系统,通过适当地操作,一般可将导线定侠于右心室心尖部;而经冠状静脉窦作左心室心外膜起搏亦是可以选择的。     

永存左上腔静脉患者左束支起搏一例

患者女性,70岁,存在永存左上腔静脉,术前诊断为间歇性三度房室传导阻滞,左后分支阻滞的患者,成功地进行了左束支起搏。术后随访6个月,各项参数稳定,患者无任何不适。     

孤立性永存左上腔静脉植入无导线起搏器一例

患者男性,87岁。因突发心悸、胸闷入院。诊断病窦综合征,拟行双腔起搏器植入;术前胸部CT提示左上腔静脉可能,双侧肘静脉造影证实永存左上腔静脉及冠状静脉窦扩张。经股静脉径路植入无导线起搏器,电极螺旋固定于右室间隔部。术后随访1个月,无心力衰竭及起搏器综合征症状,各项起搏参数良好。     

永存左上腔成功置入心脏再同步化治疗除颤器一例

永存左上腔静脉植入三腔起搏除颤器的个案报道,是通过永存左上腔静脉（PLSVC）与上腔静脉的交通支送入电极导线或直接开胸置入心外膜电极导线.现将泰达国际心血管病医院通过PLSVC成功植入三腔起搏器一例报道如下.     

孤立永存左上腔静脉畸形患者植入起搏器一例

患者男性74岁,因窦性停搏拟植入DDDR起搏器,术中发现孤立永存左上腔静脉畸形。心脏内科与心脏外科联合手术,拟经胸部小切口在胸腔镜引导下放置右房和右室心外膜电极。术中发现右室被脂肪组织包绕,被迫植入右室心内膜电极。直视下切开右房,以自行改造的心房引流管作为导引鞘管,在食管彩色超声引导下成功植入右室心内膜电极,心房电极缝于右房侧壁。术后患者恢复良好,随访起搏参数正常。     

永存左上腔静脉患者经右侧入路植入导线两例

80%~90%的永存左上腔静脉患者同时存在右上腔静脉。对于此类患者,多数经右侧入路植入起搏导线,从而降低手术难度和手术风险。临床实践中,常常在起搏器植入术中发现偶然永存左上腔静脉,目前常用的术中造影的方法有时难以区分右上腔静脉是否存在。本例在临床实践中使用泥鳅导丝的方法来鉴别右上腔静脉是否存在。该方法简单易行,便于临床...     

经永存左上腔静脉植入起搏电极导线9例分析

目的:回顾性分析经永存左上腔静脉植入起搏电极导线患者的临床资料,为临床医生提供参考。方法 :本研究入选了2009～2019年在中国医学科学院阜外医院经永存左上腔静脉植入起搏电极导线的患者9例,其中男性2例,女性7例,平均年龄为(47±25)岁。分析患者基线特征、导线类型、导线植入成功率、术中起搏参数等。术后3个月和6个月常规随访,以后每6～12个月随访。测试起搏阈值、感知及导线阻抗等参数,并随访观察并发症发生情况。结果 :9例患者中3例合并先天性心脏病,7例患者为孤立性永存左上腔静脉,2例为双上腔静脉,其中1例患者因右侧锁骨下静脉闭塞,被迫经左上腔静脉植入起搏导线,另1例患者因右锁骨下静脉留置深静脉管,选择经左上腔静脉植入起搏导线。术中2例病态窦房结综合征患者心室导线植入失败,选择植入心房单腔起搏器;1例病窦综合征患者心房导线植入失败,选择植入心室单腔起搏器。随访期间,1例患者于术后2周发现心室导线脱位,选择经右侧重新植入,其余患者未见并发症。随访中位时间1.8(1.1,4.3)年,随访期间心房、心室导线参数稳定。结论:经永存左上腔静脉植入心房、心室起搏电极导线均存在一定难度,短期内存在导线脱位风险,但远期导线参数稳定。双上腔静脉患者应避免经永存左上腔静脉植入导线。     

先天性心脏病合并永存左上腔静脉的临床分析

目的：探讨先天性心脏病合并左上腔静脉（PLSVC）畸形对心脏外科手术的影响及手术对策。方法：对我院2000年以来1921例不同类型的先天性心脏病的临床资料进行统计分析。结果：发现PLSVC46例，发生率2．4％，其中简单先心病伴发PLSVC者33例（2．0％，33／1650），复杂先心病伴发PLSVC者13例（5．5％，13／238），P〈0．01；总漏诊率37％，简单先心病伴发者漏诊率21％，复杂先心病伴发者漏诊率77％，二者差异非常显著（P〈0．01）；复杂先心合并PLSVC的6例均有Ⅰ孔房缺，且二项logistic分析显示合并ASD畸形及先心病复杂程度是合并PLSVC的危险因素。除1例Fanton术后一月死于心律紊乱，全部患者均经手术治愈出院，无PLSVC相关合并症发生。结论：（1）复杂先心病的PLSVC发病率及漏诊率均显著高于简单先心病伴PLSVC者；（2）复杂先心病、ASD畸形是合并PLSVC的危险因素，特别是Ⅰ孔房间隔缺损。     

先天性心脏病外科矫正术后Ⅱ度Ⅱ型房室传导阻滞并永存左上腔静脉患者植入永久性起搏器一例

患儿,男性,3岁,因"先天性心脏病,室间隔缺损,单心房,三尖瓣关闭不全,重度肺动脉高压"行单心房纠治术+室间隔缺损修补术+房间隔活瓣术后1年,反复晕厥半年。心电监护示房性心律,Ⅱ度Ⅱ型房室传导阻滞。成功植入VDD起搏器。术后起搏器工作良好,随访3个月晕厥症状消失。     

Pacemaker electrode implantation in patients with persistent left superior vena cava.

Four out of 661 consecutive patients with permanent endocardial VVI pacing had the pacing lead introduced through a persistent left superior vena cava. It was difficult to introduce the lead from the right atrium into the right ventricle because the tip of the lead tended to be deflected away from the tricuspid orifice. This difficulty was overcome by shaping the lead into a pigtail with 3-4 cm wide loop. This avoided the risk of entering a branch of the coronary sinus in order to reach the right atrium. This technique made it easier to position the lead in the right ventricular apex. There were no complications in these four patients during a mean follow up of three years.     

Pacemaker electrode implantation in patients with persistent left superior vena cava.

Four out of 661 consecutive patients with permanent endocardial VVI pacing had the pacing lead introduced through a persistent left superior vena cava. It was difficult to introduce the lead from the right atrium into the right ventricle because the tip of the lead tended to be deflected away from the tricuspid orifice. This difficulty was overcome by shaping the lead into a pigtail with 3-4 cm wide loop. This avoided the risk of entering a branch of the coronary sinus in order to reach the right atrium. This technique made it easier to position the lead in the right ventricular apex. There were no complications in these four patients during a mean follow up of three years.     

Absent right and persistent left superior vena cava

A patient is described presenting with atrial fibrillation. A dilated coronary sinus was found due to the presence of a persistent left superior caval vein. Absence of the right superior caval vein was suspected with contrast injection through an i.v. line in the right arm, and was confirmed with phlebography. No associated cardiac anomalies were found. Persistent left superior vena cava is a common anomaly, although simultaneous complete absence of the right superior vena cava is rare. The incidence, embryology, diagnosis and importance of this anomaly is discussed.