在右内中枢线安置中持续的左上 vena cava 的手术内识别:一个病例报告
1Department of Anesthesiology, Mount Sinai West and Morningside Hospitals, 1000 10Th Ave, New York, NY, 10019, USA. jchoi.eras2022@gmail.com.
Journal of medical case reports
|December 6, 2025
概括
持续的左上 vena cava 是一个罕见的异常,可以使中央静脉导管放置复杂化. 识别这种变体可以防止手术延迟,并提高心脏手术期间的患者安全.
科学领域:
- 心脏病学 心脏病学
- 血管外科 血管外科
- 麻醉学 麻醉学
背景情况:
- 持续的左上静脉 (PLSVC) 是一种罕见的先天性静脉异常,影响0.3-0.5%的人口.
- 它在患有先天性心脏病的患者中更为普遍 (高达10%).
- 在心脏手术期间,PLSVC可以复杂化中枢静脉导管和食道横断心声图.
研究的目的:
- 突出PLSVC在中央静脉导管治疗过程中所带来的诊断挑战.
- 强调在心声回声检查结果异常时考虑罕见的解剖变异的重要性.
- 强调在外科环境中迅速识别和管理PLSVC的策略.
主要方法:
- 一个65岁的女性正在进行中枢门修复的案例介绍.
- 在超声指导下放置右内中枢静脉导管.
- 在外科手术中,通过食道的心电回声学未能在预期的位置可视化导管尖端.
- 手术后的对比增强计算机断层扫描证实PLSVC流入冠状动脉鼻腔.
主要成果:
- 中枢静脉导管的安置在技术上是成功的,尽管异常的心声回声学发现.
- 中心门的维修工作没有发生任何事故.
- 手术后的成像检查发现了一个持续的左上 vena cava,解释了不寻常的导线轨迹.
结论:
- 中枢静脉导管治疗期间的非典型的过食管心声学发现可能表明罕见的解剖变异,如PLSVC.
- 冠状动脉鼻的向心声学和辅助成像对于诊断至关重要.
- 对PLSVC的认识和及时识别可以防止程序延迟,并提高患者的安全.
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