右腋下小切口心内直视术中永存左上腔静脉的处理

Treatment of persistent left superior vena cava in open heart surgery through right subaxillary small incision

目的总结右腋下小切口心内直视术中对永存左上腔静脉的处理方法及临床经验。方法自2009年9月～2014年1月，我们分别采用了3种方法对17例合并PLSVC异位连接冠状静脉窦的患者实施了右腋下小切口心内直视术，包括简单先心病16例，二尖瓣病变1例。其中心外套带直接临时阻断3例；右心吸引管置于冠状静脉窦口吸引显露5例；经冠状静脉窦置管引流9例。结果全组患者无住院死亡，无心律失常及其他严重并发症。随访3-6个月，均恢复良好。结论右腋下小切口心内直视术采用合理的方法处理永存左上腔静脉可取得良好效果，扩大应用范围。

Objective To summarize the methods and clinical experience of treating persistent left superior vena cava（PLSVC） in open heart surgery through right subaxillary small incision. Methods From September 2009 to January 2014, we used 3 methods to perform open heart surgery through right subaxillary small incision in 17 patients with ectopic connection between PLSVC and coronary sinus, including 16 patients with simple congenital heart disease and 1 patient with mitral valve disease. Extracardiac band temporary blocking was applied in 3 patients; Right heart suction tube was placed in coronary sinus ostium for revealing in 5 patients; Coronary sinus catheter drainage was applied in 9 patients. Results No hospitalization death, arrhythmia or other severe complications occurred. Three to six months of follow-up observed good recovery. Conclusion In the open heart surgery through right subaxillary small incision, an appropriate method to treat the persistent left superior vena cava can obtain favorable effects and expand the application range.