与肺切除术相关的肺静脉部分异常连接矫正:病例报告。

IF 0.7 Q4 SURGERY Surgical Case Reports Pub Date : 2024-11-21 DOI:10.1186/s40792-024-02070-x
Kosuke Nakata, Jun Takaki, Toshihiro Fukui
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引用次数: 0

摘要

简介部分异常肺静脉连接(PAPVC)是导致右侧心力衰竭的潜在原因。值得注意的是,在肺部手术中存在突然循环衰竭的风险。目前仅有少数肺癌并发 PAPVC 并需要进行肺叶切除术的报道。在此,我们报告了一例左下肺叶切除术并发左上肺静脉异常连接而需要血管重建的病例:一名 66 岁的男性在胸片检查中发现左下肺野有异常肿块影。支气管镜检查发现肺腺癌。术前对比增强计算机断层扫描显示,左上肺静脉没有灌注左心房,而是与左肱静脉相连。术前经胸超声心动图显示右心房和心室扩大。临床诊断为IB期(T2aN0M0)。我们决定进行左下肺叶切除术,并在肺叶切除术后矫正 PAPVC 以维持氧合。PAPVC被结扎,左上肺静脉残端与左心房阑尾吻合,无需心肺旁路。术后对比增强计算机断层扫描显示重建的血管完好无损。术后经胸超声心动图显示没有右心室负荷过重。患者术后临床过程顺利。此外,患者在后续治疗中未出现任何并发症:这一罕见的手术矫正成功病例可为临床医生提供类似病例的参考。
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Corrected partial anomalous pulmonary vein connection associated with lung resection: a case report.

Introduction: Partial anomalous pulmonary venous connection (PAPVC) is a potential cause of right-sided heart failure. Notably, a risk of sudden circulatory failure exists during lung surgery. Only a few reports of PAPVC complicated by lung cancer requiring lobectomy exist. Here, we report a case of left lower lung lobectomy complicated by an anomalous connection of the left upper pulmonary vein requiring revascularization.

Case presentation: A 66-year-old man was found with an abnormal mass shadow in the left lower lung field on chest radiography. Bronchoscopy revealed lung adenocarcinoma. Preoperative contrast-enhanced computed tomography showed that the left upper pulmonary vein did not perfuse the left atrium but was connected to the left brachiocephalic vein. Preoperative transthoracic echocardiography revealed right atrial and ventricular enlargement. The clinical diagnosis was stage IB (T2aN0M0). We decided to perform a left lower lobectomy and correct the PAPVC to maintain oxygenation after the lobectomy. The PAPVC was ligated, and the stump of the left upper pulmonary vein was anastomosed to the left atrial appendage without cardiopulmonary bypass. Postoperative contrast-enhanced computed tomography revealed intact reconstructed vessels. Postoperative transthoracic echocardiography showed no right ventricular overload. The patient's postoperative clinical course following the surgical procedure was uneventful. Furthermore, the patient was followed up without any complications.

Conclusions: This rare case of successful surgical correction can inform clinicians of similar cases.

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