目的对孤立性永存左上腔静脉畸形(persistent left superior vena cava,PLSVC)的临床特点、自然病程及诊治经验进行系统性分析,以期减少临床漏诊率。方法采集、整理北京积水潭医院1例78岁孤立性PLSVC患者的症状体征演变史及其近21年历...目的对孤立性永存左上腔静脉畸形(persistent left superior vena cava,PLSVC)的临床特点、自然病程及诊治经验进行系统性分析,以期减少临床漏诊率。方法采集、整理北京积水潭医院1例78岁孤立性PLSVC患者的症状体征演变史及其近21年历次就诊的检查资料,进行比较分析。结果该例患者57岁出现心慌的首发症状,11年前因"病态窦房结综合征"安装双腔起搏器,术前检查外周血白细胞、血小板减低,术中发现PLSVC,7年前开始出现腹腔静脉淤血表现,5年前因重度三尖瓣反流、右心功能不全而就诊,3个月前胸部增强CT加血管重建明确为孤立性永存左上腔静脉畸形。结论孤立性永存左上腔静脉阳性症状出现晚,首发症状常为各种心律失常,临床极易漏诊误诊,心脏查体可于早期闻及三尖瓣收缩期杂音,超声心动图为首选筛查手段,心导管检查或增强CT加血管重建可明确诊断。其心律失常治疗包括起搏器植入术及冠状窦靶点消融。部分患者需早期手术治疗,疾病晚期可考虑心脏移植术。展开更多
<div style="text-align:justify;"> A persistent left superior vena cava (PLSVC) is a rare malformation which affects approximately 0.3<span>% </span><span>-</span><span> &l...<div style="text-align:justify;"> A persistent left superior vena cava (PLSVC) is a rare malformation which affects approximately 0.3<span>% </span><span>-</span><span> </span><span>0.5% of the population and it is presented along with a right-sided superior vena cava in 82.2% of the cases reported</span><span minion="" pro="" capt","serif";color:#943634;"="" style=""> </span><span minion="" pro="" capt","serif";color:#943634;background:yellow;"=""></span><span>[<a href="#ref1">1</a>]</span><span color:#943634;background:yellow;"=""></span><span minion="" pro="" capt","serif";color:#943634;background:yellow;"=""></span><span>.</span><span "=""><span> Clinicians diagnose it incidentally by difficulties with pacemaker implantation, central venous catheterization or screening for another etiologies when it is not accompanied by other anomalies it is typically asymptomatic. W. Schummer </span><i><span>et al.</span></i><span> described the embryogenesis and the anatomic variations of persistent LSVC according to the positioning of a central venous catheter on the chest radiograph: type I, normal;type II, only PLSVC;type IIIa, right and left superior vena cava with connection;type IIIb, right and left superior vena cava without connection</span></span><span> </span><span>[<a href="#ref2">2</a>]</span><span>. </span><span "=""><span>In 92% of individuals with PLSVC, the PLSVC drains into a dilated coronary sinus (CS) and rest 8% drain directly into the left atrium. PLSVC is caused by a failure in the closure of the left anterior cardinal vein during embryogenic development</span></span><span minion="" pro="" capt","serif";color:#943634;"=""><span> </span><span style="background:yellow;"></span></span><span color:#943634;"=""><span>[<a href="#ref3">3</a>]</span><span style="background:yellow;"></span></span><span minion="" pro="" capt","serif";color:#943634;background:yellow;"=""></span><span>. </span><span>The coronary sinus (CS) is a vein that transmits venous blood to the right atrium though atrioventricular groove. The CS wall contains atrial myocardium. Thus, it</span><span>s size</span><span> extensively depend</span><span>s</span><span> on variability of blood flow and pressure. We present a variant PLSVC with unknown prevalence and a mild </span><span>platypnea-orthodeoxia</span><span> </span><span>syndrome</span><span> after recovery of COVID-19 related acute respiratory distress syndrome (ARDS).</span> </div> <a href="#ref2"></a>展开更多
文摘目的对孤立性永存左上腔静脉畸形(persistent left superior vena cava,PLSVC)的临床特点、自然病程及诊治经验进行系统性分析,以期减少临床漏诊率。方法采集、整理北京积水潭医院1例78岁孤立性PLSVC患者的症状体征演变史及其近21年历次就诊的检查资料,进行比较分析。结果该例患者57岁出现心慌的首发症状,11年前因"病态窦房结综合征"安装双腔起搏器,术前检查外周血白细胞、血小板减低,术中发现PLSVC,7年前开始出现腹腔静脉淤血表现,5年前因重度三尖瓣反流、右心功能不全而就诊,3个月前胸部增强CT加血管重建明确为孤立性永存左上腔静脉畸形。结论孤立性永存左上腔静脉阳性症状出现晚,首发症状常为各种心律失常,临床极易漏诊误诊,心脏查体可于早期闻及三尖瓣收缩期杂音,超声心动图为首选筛查手段,心导管检查或增强CT加血管重建可明确诊断。其心律失常治疗包括起搏器植入术及冠状窦靶点消融。部分患者需早期手术治疗,疾病晚期可考虑心脏移植术。
文摘<div style="text-align:justify;"> A persistent left superior vena cava (PLSVC) is a rare malformation which affects approximately 0.3<span>% </span><span>-</span><span> </span><span>0.5% of the population and it is presented along with a right-sided superior vena cava in 82.2% of the cases reported</span><span minion="" pro="" capt","serif";color:#943634;"="" style=""> </span><span minion="" pro="" capt","serif";color:#943634;background:yellow;"=""></span><span>[<a href="#ref1">1</a>]</span><span color:#943634;background:yellow;"=""></span><span minion="" pro="" capt","serif";color:#943634;background:yellow;"=""></span><span>.</span><span "=""><span> Clinicians diagnose it incidentally by difficulties with pacemaker implantation, central venous catheterization or screening for another etiologies when it is not accompanied by other anomalies it is typically asymptomatic. W. Schummer </span><i><span>et al.</span></i><span> described the embryogenesis and the anatomic variations of persistent LSVC according to the positioning of a central venous catheter on the chest radiograph: type I, normal;type II, only PLSVC;type IIIa, right and left superior vena cava with connection;type IIIb, right and left superior vena cava without connection</span></span><span> </span><span>[<a href="#ref2">2</a>]</span><span>. </span><span "=""><span>In 92% of individuals with PLSVC, the PLSVC drains into a dilated coronary sinus (CS) and rest 8% drain directly into the left atrium. PLSVC is caused by a failure in the closure of the left anterior cardinal vein during embryogenic development</span></span><span minion="" pro="" capt","serif";color:#943634;"=""><span> </span><span style="background:yellow;"></span></span><span color:#943634;"=""><span>[<a href="#ref3">3</a>]</span><span style="background:yellow;"></span></span><span minion="" pro="" capt","serif";color:#943634;background:yellow;"=""></span><span>. </span><span>The coronary sinus (CS) is a vein that transmits venous blood to the right atrium though atrioventricular groove. The CS wall contains atrial myocardium. Thus, it</span><span>s size</span><span> extensively depend</span><span>s</span><span> on variability of blood flow and pressure. We present a variant PLSVC with unknown prevalence and a mild </span><span>platypnea-orthodeoxia</span><span> </span><span>syndrome</span><span> after recovery of COVID-19 related acute respiratory distress syndrome (ARDS).</span> </div> <a href="#ref2"></a>