先天性心脏病合并右上腔静脉缺如及永存左上腔静脉畸形的治疗

目的 探讨先天性心脏病合并右上腔静脉缺如及永存左上腔静脉畸形的治疗方法。方法 手术治疗2例,在全麻体外循环下行矫治术。1例采用左上腔静脉直接插管法,1例采用心内冠状静脉窦插管法。结果 2例均治愈,远期无心律失常发生。结论 先天性心脏病中,左上腔静脉合并右上腔静脉缺如非常少见,认识不足,是造成漏诊的主要原因。术中应根据情况酌情处理,但无论采取哪种方法,一定要注意对冠状静脉窦口的保护及左上腔静脉引流的通畅。     

The left atrial notch: a sign of persistent left superior vena cava draining to the right atrium

A notch in the inferior border of the left atrium has been observed in patients with a persistent left superior vena cava draining via the coronary sinus into the right atrium. It is suggested that the notch is due to the dilated coronary sinus.     

左上腔静脉永存合并右上腔静脉缺如植入起搏器一例

左上腔静脉永存(LSVC)是由于在胎儿发育早期阶段静脉窦发育异常.LSCV是一种罕见的体静脉连接异常,在正常人群中的发生率为0.3%,而在心脏植入起搏器患者中发生率为0.47%[1].在这种情况下,起搏器植入(PMI)是非常困难,甚至是不可能完成的.     

Demonstration of persistent left superior vena cava by first pass radionuclide angiography

A case of the left superior vena cava draining to the coronary sinus without associated intracardiac shunt was initially demonstrated by first pass radionuclide angiography. The patient had atypical chest pain for 8 years, and had sick sinus syndrome with a long cardiac pause. Cardiac catheterization confirmed this diagnosis, and a transvenous pacemaker was successfully implanted through the left superior vena cava.     

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.     

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.     

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.     

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.     

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.     

Treatment of the superior vena cava syndrome

The author describes the results of therapy in three groups of patients (128 patients altogether) with the superior vena cava syndrome caused by a tumorous disease. All the patients were treated by radiotherapy as a main method of therapy. (200 kV, filtration 2 mm Cu) in a daily fractionation 300 r on the surface by one field, in the second period (1974-1978) 55 patients were irradiated by 60Co cobalt from two opposite fields by daily fractionation of 170-180 rad into the focus and in the third period (1984-1986) 25 patients were irradiated by 60Co cobalt from two opposite fields in 3-4 introductory daily fractions 3.0 Gy into the focus and then in normal fractionation up to the total dose planned. Immediate results of the treatment--complete disappearance of the syndrome symptoms--were the best in the 3rd group, where a complete disappearance of the symptoms was observed in 84% of patients and a partial relief in 8%. In the first period a complete disappearance of symptoms was in 54% and a partial relief in 10% of patients. The corresponding values in the second period were 74% and 11% respectively. In evaluating the survival of patients, no significant differences were found. In the first period, 50% of patients survived 12 weeks, in the second period 16 weeks and in the third one 20 weeks. One-year survival was reached by two per cent of patients in the first period, four per cent in the second period and eight per cent in the third period. The paper discusses other therapeutic possibilities and approaches in the treatment of the superior vena cava syndrome.     

Right nutcracker syndrome associated with left-sided inferior vena cava,hemiazygos continuation and persistant left superior vena cava: a rare combination

The term nutcracker syndrome refers to compression of left renal vein between aorta and superior mesenteric artery causing renal venous hypertension. Right nutcracker syndrome associated with a left-sided inferior vena cava is an extremely rare anomaly. Reported two cases in English literature were diagnosed by ultrasonography and computed tomography angiography in adulthood. Herein, we present a case of right nutcracker syndrome with left-sided inferior vena cava and hemiazygos continuation in a 12-year-old girl.     

The vena cava superior syndrome in sarcoidosis

We report the first observation of clinical manifestations of vena cava superior syndrome (VCSS) associated with sarcoidosis. Twenty-four years after the first signs of the disease had been noted, mediastinal lymphomas penetrating the wall of the vena cava superior caused complete obstruction. It is most unusual for the vessel wall to be destroyed in this way, which explains why VCSS is often missed in sarcoidosis. The obstructed vessel was resected and successfully replaced by a Gore-Tex prosthesis. The importance of VCSS for the differential diagnosis is pointed out. Two further peculiarities are the simultaneous occurrence of elevated intraocular pressure and VCSS, and the familial incidence.