入心静脉口环状超声消融动物实验

观察入心静脉口环状超声消融对心电传导及影像学的影响 ,探讨超声消融在治疗局灶源性心房颤动 (简称房颤 )中的临床价值。选用健康成年杂种犬 7只 ,用特制的超声球囊导管和温控大头导管在S1S1快速刺激下分别环状消融肺静脉口和上、下腔静脉口。超声消融时预设温度 60℃、功率 2 0W、脉宽 15ms,3 0 %输出方式 ;若放电 10s后温度达不到 5 0℃ ,则加大功率、脉宽或输出方式 ,直至达到有效消融温度 ( 5 5℃以上并持续 3 0s以上 ) ;观察消融前后心电传导的变化及管腔形态的变化。结果 :共超声消融入心静脉口 10个 ,除一个上腔静脉口因管腔直径过大只在放电时引起一过性电隔离外 ,其余 9个超声消融后都可造成持久的电隔离 ,且未见急性狭窄 ;而 7个射频消融的入心静脉口无一例形成持久的电隔离 ,且有 4例发生急性狭窄。结论 :超声消融更易在入心静脉口形成完全、持久的电隔离 ,很少导致管腔狭窄 ,且操作简单 ,安全可靠 ,优于射频消融。     

Reconstruction of superior vena cava in invasive thymoma

Aggressive en-bloc resection of the superior vena cava was performed in a 50-year-old man who had superior vena caval syndrome caused by invasive thymoma. After the superior vena cava was resected, a Gore-Tex vascular graft was used to reconstruct the lower end of the right innominate vein and lower end of the superior vena cava. The patient was treated with postoperative radiotherapy to the mediastinum and has been asymptomatic for 14 months following surgery.     

Unusual venacaval anomalies in a patient with atrial septal defect

An unusual systemic venous drainage pattern was found in a 30-year-old man with ostium secundum atrial septal defect and pulmonary stenosis. He had the rare association of absent right superior vena cava, persistent left superior vena cava draining into the coronary sinus, and a left-sided inferior vena cava draining into a left superior vena cava through the hemiazygous vein.     

Implantable cardioverter defibrillatory implantation in a patient with persistent left superior vena cava and right superior vena cava atresia

Persistence of a left superior vena cava has been observed in 0.3% of the general population as established by autopsy findings. In the adult population. it is an important anatomic finding if a left or right superior vena cava approach to the heart is considered for device implantation. We present a case with persistent left superior vena cava and right superior vena cava atresia in whom a dual chamber implantable cardioverter defibrillator was implanted and was technically challenging.     

Permanent Pacemaker Implantation in Patients with Persistent Left Superior Vena Cava

A world survey of 34 patients with persistent left superior vena cava who required permanent pacing is reviewed and one case of ours with dominant left superior vena cava is reported. Based on these cases, we conclude that the transvenous, rather than epicardial placement of a permanent pacemaker lead is the procedure of choice in patients with persistent left superior vena cava, with or without coexisting right superior vena cava.     

Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects

The hemodynamic manifestations of the Valsalva maneuver are in part the result of changes in the venous return accompanying changes in intrathoracic pressure. Doppler echocardiography was performed during Valsalva maneuver in 13 normal subjects. Superior vena cava flow velocities and flow velocity integrals were measured in all 13 subjects. In the 5 subjects in whom the superior vena cava was clearly visualized throughout the maneuver, vena cava diameter was also analyzed. The superior vena cava flow velocity integral at rest was 17 +/- 2 cm. It diminished significantly, disappeared or reversed (-13 +/- 6 cm, p less than 0.001) with phase I of the maneuver. During the maintenance phase (phase II), the flow velocity integral increased significantly (31 +/- 2 cm, p = 0.05 vs baseline and phase I) and was associated with a decrease in superior vena cava lumen diameter at the time of Valsalva and continuing throughout the strain. With release of the maneuver (phase III), there was a sudden significant increase in flow velocity integral (61 +/- 2 cm, p = 0.005 vs phase II) and superior vena cava lumen diameter. Subsequently, superior vena cava flow velocity integral returned to baseline values. This study suggests that one of the ways in which the Valsalva maneuver leads to decreased venous return may be by direct external compression of the superior vena cava.     

Superior vena cava anomalies in the generation of angina pectoris: a report of two cases

Superior vena cava anomalies are rare occurrences caused by variations in the development of the embryonic venous system. Persistent left superior vena cavae are the most common congenital aberrations in the thoracic venous system, with an incidence of 0.3-0.5%, but their association in the absence of a right superior vena cava is extremely rare and scarcely reported. We report two case studies describing persistent left superior vena cavae found with and without a right superior vena cava in patients presenting with chest pain. A discussion regarding superior vena cava abnormalities as well as the etiology, associations, and diagnosis of these unusual entities follows.     

Double superior vena cava with drainage of the right superior vena cava into the left auricle. Presentation as a cerebral abscess in an adult

A 44 year old man presented with a cerebral abscess, the location of which suggested a septicaemic origin. Although the patient was not cyanosed, a cardiological work-up was requested to exclude a right-to-left shunt. This showed a double abnormality of the systemic venous drainage: presence of an abnormal left superior vena cava draining into the coronary sinus and of a right superior vena cava draining into the left atrium. These two vena cava intercommunicated by anastomoses. Angiography in the right superior vena cava after occlusion by balloon catheter at its junction with the left atrium showed flow from the right to the left superior vena cava and to the azygos system. Simple ligature of the right superior vena cava was therefore performed to prevent recurrence of cerebral abscess. This case is rare and of interest because of the presence of two superior vena cavae, one on the right draining into the left atrium and the other on the left draining into the coronary sinus, with anastomoses between the two superior vena cavae. This double abnormality of systemic venous drainage explains the absence of cyanosis and therefore the relatively late detection of this malformation.     

经上腔静脉途径射频消融右侧前上和前间隔房室旁道

报道经上腔静脉途径射频消融右侧前上和前间隔房室旁道的体会。 13例右侧前上或前间隔单一房室旁道患者 ,常规下腔静脉途径消融未能成功 ,失败原因包括 :消融电极与心肌接触不良或难以固定于三尖瓣环上。改经上腔静脉途径成功消融阻断所有房室旁道。平均放电 1.8± 0 .7次 ,输出功率 33± 4W ,消融靶点电图振幅明显高于下腔静脉途径 (1.4± 0 .3mVvs 0 .6± 0 .4mV ,P <0 .0 5 )。术后随访 17± 9个月 ,无 1例复发。作者认为对经下腔静脉途径消融失败的右侧前上和前间隔房室旁道采用上腔静脉途径消融可获得成功。     

Persistent left superior vena cava,absent right superior vena cava and coronary-bronchial fistula: The good,the bad and the ugly (case report and review of literature)

A 62-year-old Caucasian male presented with syncope during casual daily activity without preceding prodromes. During ECG Holter monitoring, we observed numerous asystolic pauses lasting >4 s due to sino-atrial blockade and sinus bradycardia. During pacemaker implantation, persistent left superior vena cava with agenesis of the right superior vena cava was diagnosed. Unproblematic placement of atrial lead was followed by challenging placement of the right ventricular lead. Anterior position with a sharp angulation to the right ventricular wall was achieved with excellent stimulation parameters. Transesophageal echocardiography confirmed the diagnosis of persistent left superior vena cava with agenesis of right superior vena cava. Moreover, selective coronary angiography showed connection between right coronary artery branch and bronchial vessel. To the best of our knowledge, we are the first to describe a combination of persistent left superior vena cava with absent right superior vena cava, coronary-bronchial fistula and conduction abnormality with the necessity of device implantation.     

Pleural effusions in superior vena cava syndrome: prevalence, characteristics, and proposed pathophysiology

PURPOSE OF REVIEW: This review highlights recent data detailing the prevalence and characteristics of pleural effusions occurring in patients with superior vena cava syndrome. RECENT FINDINGS: Numerous case reports have described pleural effusions in conjunction with the superior vena cava syndrome. Recent data suggest that these effusions occur in 60% of superior vena cava syndrome cases. The effusions are small, usually occupying less than half the affected hemi-thorax, and occur about equally on either side or bilaterally. Although previously thought to be largely transudates, a large case series found that 18% of the effusions were chylous, with the remainder being exudates. None of the effusions sampled in the series were transudates. Occluded lymphatic flow from increased hydrostatic pressure in the superior vena cava and left brachiocephalic vein probably contributes to the development of chylous pleural fluid. The pathophysiology of the exudative effusions, however, remains unknown. Many factors, including diuresis, small pulmonary emboli, and the underlying inflammatory or malignant condition all likely contribute. SUMMARY: Chylous or exudative pleural effusions occur in most patients with superior vena cava syndrome. The effusions are usually small and resolve upon correction of the underlying superior vena cava obstruction.     

经下腔静脉途径拔除起搏导线的初步体会

目的 介绍应用血管内反推力技术经下腔静脉途径拔除起搏导线的初步临床体会。方法 对１８例患者的２８根导线应用血管内反推力牵引技术拔除导线,其中１６例（２５根导线）首选经上腔静脉途径,失败后改用经下腔静脉途径;２例（３根导线）直接用经下腔静脉途径拔除。结果 １６例患者的２５根导线,经上腔静脉途径完全拔除２２根（８８％）,３根经此途径拔除失败后改用下腔静脉途径,其中２根完全拔除。２例患者的３根导线直接先     

Sinus node dysfunction associated with absence of right superior vena cava.

A 41-year-old man presented with dizziness associated with sinus bradycardia and sinus arrest. An attempt to implant a transvenous pacing lead was frustrated by absence of the right superior vena cava. The left superior vena cava persisted and drained via the coronary sinus into the right atrium. Absence of the right superior vena cava may present with symptomatic sinus node dysfunction and may require an epicardial demand pacing system.     

Persistent left superior vena cava and pacemaker implantation

Our study group read with interest the paper from Vijayvergiya et al describing the implantation of an implantable cardioverter-defibrillator lead in the presence of the persistence of the left superior vena cava.The issue of the identification a persistent left superior vena cava is of paramount importance in interventional cardiology,being the most common venous anomaly of the thoracic distribution,and because it may create some problem to any physician while performing a pacemaker lead implantation.In our letter we underscore the specific issues related to pacemaker implantation while encountering a persistent left superior vena cava(and maybe the absence of the right vena cava)and the workup that should be performed to obtain the preoperative diagnosis of the venous anomaly.More specifically,we consider avoiding any kind of defibrillator lead implantation through the coronary sinus for safety issues,and underscore the straightforward transthoracic ultrasound approach to identify the left superior vena cava.     

Two cases of left superior vena cava draining directly to a left atrium with a normal coronary sinus.

The most common variation in the thoracic systemic venous system is a persistent left superior vena cava draining to a coronary sinus. A rare anomaly is a persistent left superior vena cava connecting directly to the left atrium. In this situation it is believed that the coronary sinus must be absent. This report describes two cases of a persistent left superior vena cava draining to a left atrium with a normal coronary sinus.     

胸部肿瘤引起上腔静脉综合征的治疗及进展

上腔静脉综合征（superiorvenacavasyndrome,SVCS）又称上腔静脉阻塞综合征,是上腔静脉或其周围的病变引起上腔静脉完全或不完全性阻塞,导致经上腔静脉回流到右心房的血液部分或全部受阻,从而引起的急性或亚急性的呼吸困难和上肢、颈和颜面部瘀血水肿,以及上半身浅表静脉曲张,进一步发展可导致缺氧和颅内压升高的一组临床症候群。影像学检查有助于诊断,其中传统可以确定阻塞部位和性质,静脉造影可发现阻塞范围、程度和侧支循环情况。放射治疗能使大部分恶性肿瘤所致的症状有所缓解。本文对SVCS的各项治疗有所介绍,其中对外科治疗有详细介绍。     

Mitral valve replacement in patient with absent right superior vena cava, pectus excavatum, Marfan syndrome and severe mitral regurgitation

Combination of persistent left superior vena cava (PLSVC) draining into right atrium via the coronary sinus with a normal right superior vena cava (RSVC) is the most common systemic venous anomaly in visceroatrial situs solitus. On the other hand, a PLSVC in absence of RSVC is an extremely rare anomaly. Cardiovascular abnormalities are frequently encountered in patients with Marfan's syndrome but absence of RSVC with PLSVC is not reported in these patients. We report on a 52-year-old man with Marfan syndrome, an absence of right superior vena cava, severe pectus excavatum and severe mitral regurgitation who underwent successful mitral valve replacement. CT scan chest revealed marked cardiac deviation to the left associated with severe pectus excavatum, absent right superior vena cava and persistent left superior vena cava. During surgery replacement of mitral valve was performed through midsternotomy successfully.     

累及上腔静脉的肺癌外科治疗效果探析

目的探析肺癌累及上腔静脉的外科治疗效果。方法将我院2008年5月至2010年5月经手术治疗的肺癌累及上腔静脉患者30例作为研究对象,将其临床资料进行回顾性分析,记录患者上腔静脉压力及阻断时间的测量结果;上腔静脉置换患者给予膨体聚四氟乙烯人工血管治疗;运用4-0Prolene无创伤滑线进行缝合;观察术后患者吻合口出血等情况。结果上腔静脉置换19例患者中,未阻断的患者有5例,上腔静脉阻断患者的阻断时间为10～32 min。阻断患者的上腔静脉压力在术前测定为30 KPa,术中最高压力为40 KPa。整个围术期及手术中未出现死亡现象;12例患者术后出现肺炎、肺不张、心功能不全、心律失常等并发症。结论治疗过程中,减少上腔静脉阻断时间可避免患者出现脑水肿;选择适宜的人工血管,运用无创伤滑线连续外翻缝合,可有效控制出血、血管栓塞的症状。     

Obstruction of the superior vena cava caused by sclerosing mediastinitis. Surgical treatment by bypass with a composite spiral venous graft

A 68-year-old woman with obstruction of the superior vena cava due to sclerosing mediastinitis was successfully operated on. A composite spiral vein graft was interposed between the left innominate vein and the right atrium to bypass the occluded superior vena cava. The graft was made using the patient's own saphenous vein, which was divided longitudinally and sutured around a cannula in a spiral fashion. Indications to surgical intervention in patients with superior vena cava syndrome are discussed.