Left Superior Vena Cava

[김기환/강원대]

얼마전  AR 환자의 AVR 수술을 위해 chest 를 열어보고는 스텝 선생님 이하 우리 모두가 깜짝 놀란일이 있습니다.

환자가 Left-SVC 를 가지고 있었습니다. Left-SVC 를 별로 볼 기회가 없었는데,,,오랜만에 봐서 그런것도 있지만

내과에서 전혀 그런 얘기가 없었기 때문이기도 합니다.^^

그래서 그런지 Retrograde cardioplegia 가 압력이 제대로 걸리지 않는 것이 제대로 들어가지도 않았고 반대쪽 right SVC로 넘어가는 shunt 가 있는지 both coronary direct 로도 세는듯 압력이 제대로 걸리지 않아서 애를 먹었습니다.^^

다행히도 수술이 잘 끝나서 지금 환자는 병동에 올라가 걸어다니고 있는데요.

논문이나 발표 자료를 찾아봐도 많지는 않네요.

혹시 Left-SVC 에 대한 자료를 가지고 계신 선생님들께서는 좀 올려 주세요.^^

Pulmonary Artery Catheter in the Coronary Sinus: Implications of a Persistent
Left Superior Vena Cava for Retrograde Cardioplegia

Left Superior Vena Cava for Retrograde Cardioplegia.pdf

A persistent left superior vena cava

  A persistent left superior vena cava.pdf

Persistent Left Superior Vena Cava 

• Incidence-uncommon
  • 0.3% of general population;
  • 4.3-11% of patients with CHD
• Two types
  • Persistent left SVC connecting to right atrium via coronary sinus is only common anomaly of SVC (90% of this anomaly)
  • In other 10%, persistent SVC connects to left atrium
    • Most with connection to left atrium have associated ASD or heterotaxy syndromes
    • This produces a right-to-left shunt of a rather small magnitude
• Etiology
  • Failure of regression of left anterior and common cardinal veins and left sinus horn
• Course of persistent left SVC
  • Draining into right atrium
    • Starts at junction of left subclavian vein and left internal jugular
    • Passes lateral to aortic arch
    • Receives left superior intercostal vein
    • Anterior to left hilum
    • Joined by hemiazygous system
    • Crosses posterior wall of left atrium
    • Receives great cardiac vein to become coronary sinus (common)

Yellow arrows point to left-sided persistent SVC
passing lateral to aortic arch and anterior to left hilum

• Draining into left atrium
  • Starts at junction of left subclavian vein and left internal jugular
  • Passes lateral to aortic arch
  • Receives left superior intercostal vein
  • Anterior to left hilum
  • Joined by hemiazygous system
  • Passes between the left atrial appendage (anteriorly) and the left superior pulmonary vein posteriorly

• Absent / small left brachiocephalic vein (65%)
• Really this abnormality produces bilateral SVCs
• In small percentage, right SVC is absent (10-18%)