合并永存左上腔静脉畸形的快速心律失常的经导管射频消融治疗

阐明合并永存左上腔静脉畸形 (PLSVC)的快速心律失常经导管射频消融治疗的方法学和特殊性。自 1 997年 6月至 2 0 0 1年 6月共对 1 3例合并PLSVC的快速心律失常进行了经导管射频消融治疗 ,其中房室结折返性心动过速 (AVNRT) 7例、左侧旁道 3例 ;右侧旁道、房性心动过速 (简称房速 )和室性心动过速 (简称室速 )各 1例。冠状静脉窦标测电极均常规经左锁骨下静脉放置 ,其中 9例进行了冠状静脉窦造影 ,3例左侧旁道中的 2例采用了经主动脉逆行法消融、1例采用穿间隔法在二尖瓣环心房侧消融 ,7例AVNRT中的 5例采用Swartz鞘管支持消融导管实现稳定贴靠。消融成功率 1 0 0 % ,无并发症。结论 :多种快速心律失常可合并PLSVC ,经导管射频消融仍有较高的成功率 ,但是在冠状静脉窦电极放置、冠状静脉窦标测和AVNRT消融的方法学上有一定特殊性。

产前超声诊断永存左上腔静脉及其合并畸形的价值

永存左上腔静脉（persistent left superior vena cava,PLSVC）是最常见的体循环静脉畸形,发生率约为0.3%～0.5%,占所有先天性心脏病的2.8%～4.3%,可以单独存在,也可合并其他心内外畸形。本组回顾性分析86例PLSVC胎儿及其合并畸形的相关资料,总结PLSVC的声像图特征、伴发畸形及围产结局,旨在提高产前超声对该病的认识。

超声多切面联合扫查诊断胎儿永存左上腔静脉

永存左上腔静脉（permanent left superior vena cava,PLSVC）是一种较常见的体静脉异常连接。胎儿PLSVC提示发生心脏畸形的危险性明显增加,尤其是主动脉缩窄及发育不良的可能性增加[1]。

孤立性永存左上腔静脉畸形的临床研究

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。

体外循环心内直视手术中永存左上腔静脉的处理探讨

目的探讨体外循环手术时永存左上腔静脉(PLSVC)的发生率,总结手术处理经验。方法回顾性分析体外循环手术中所见PLSVC22例,占同期心内直视手术患者的2.3%(22/977),手术在全麻和中度低温体外循环下进行,根据不同情况分别对PLSVC采取套带阻断(8例)、插管引流(8例)、直接结扎(5例)或不做特殊处置(1例)等方法,保证手术的顺利实施。结果本组手术无死亡患者。16例患者术毕放置心表起搏电极,其中3例术后短期应用起搏器(1～3d)。1例法乐氏四联症患者发生左侧急性硬膜外血肿,清除后顺利恢复。所有患者术后随访1～10年,均无神经并发症,无远期死亡。结论 PLSVC发生率低,体外循环手术应重视。根据术中不同情况处置PLSVC既有利于手术操作,又不会对患者造成伤害,术毕应放宽心表起搏电极应用指征。

A Case Report about Persistent Left Superior Vena Cava: Is it Always Asymptomatic?

A persistent left superior vena cava (PLSVC) is a rare malformation which affects approximately 0.3% - 0.5% of the population and it is presented along with a right-sided superior vena cava in 82.2% of the cases reported [1]. 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 et al. 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 [2]. 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 [3]. 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, its size extensively depends on variability of blood flow and pressure. We present a variant PLSVC with unknown prevalence and a mild platypnea-orthodeoxia syndrome after recovery of COVID-19 related acute respiratory distress syndrome (ARDS).

造影超声心动图诊断永存左上腔静脉合并先天性心脏病(附10例报告)

本文总结了10例永存左上腔静脉(PLSVC)合并先天性心脏病。10例中9例经手术证实,8例经二维超声心动图及造影超声心动图诊断。本文认为先天性心脏病手术前,常规进行二维超声心动图和造影超声心动图检查是很有必要的。

食管闭锁患儿永存左上腔静脉的发生率

Purpose:Esophageal atresia is known to be associated with a variety of additi onal congenital anomalies in multiple organ systems.Emphasis on cardiovascular anomalies has been focused on aortic arch and intrinsic cardiac malformations.P ersistent left superior vena cava(PLSVC)is the most common venous thoracic ano maly in the general population and creates a problem when central venous access is required.This review was undertaken to define the incidence of PLSVC in infa nts with esophageal atresia and to determine if any subgroup of associated anoma lies poses additional risk.Methods:A retrospective,institutional review board-approved review of all children treated for esophageal atresia from 1993 to 20 02 at Riley Hospital for Children was undertaken.Of 118 children,89 had suffic ient data for inclusion.Charts were reviewed for gestational age,weight,type of atresia,echocardiogram,and associated anomalies.Statistical analysis was p erformed using the Fisher’s Exact test.Results:Of 89 children,8(9.9%;conf idence interval,4%-17%)had PLSVC compared with the reported incidence of 0.3%in the general population.Presence of additional organ system anomalies did not significantly increase relative risk for PLSVC.Conclusion:The incidence of PLSVC is significantly increased in children with esophageal atresia when compa red with the general population.This increased incidence of PLSVC is not influe nced by the presence of cardiac or other associated anomalies.This finding shou ld be kept in mind when central venous access is required in this patient popula tion.

产前心超诊断永存左上腔静脉引流入左房的价值

文章回顾性分析5例经产前超声诊断为永存左上腔静脉引流入左房的超声资料及随访结果,总结其超声声像图特点,探讨产前超声诊断永存左上腔静脉引流入左房的价值。

左上腔静脉永存合并房室结折返性心动过速的电生理机制及导管射频消融

左上腔静脉永存(permnnent left superior vena cava,PLSVC)即左锁骨下静脉与颈内静脉汇合后不与右侧无名静脉相融形成上腔静脉,而直接沿脊柱左缘下行在心脏后面与心脏静脉相融合形成巨大的冠状静脉窦,血液由此汇入右心房.孤立性的PLSVC对人体血流动力学并无影响,是良性的血管畸形,在正常人群中其发生率为0.5%[1].

永存左上腔静脉的特征及留置透析导管二例分析

永存左上腔静脉（persistent left superior vena cava，PLSVC）是胸腔内血管畸形的一种常见类型，因血管走形异常，伴或不伴右上腔静脉缺如等情况，在中心静脉插管操作过程中，以及经PLSVC留置导管透析过程中。常出现意想不到的并发症，给肾科医师带来困惑。本文分析2例维持性血液透析患者PLSVC的诊断过程，