Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지

Left Ventricular Inflow Obstruction Caused by a Persistent Left Superior Vena Cava and a Dilated Coronary Sinus - A case report -

관상정맥동 확장에 의한 좌심실 유입로 폐쇄 - 1예 보고 -

  • Sim, Hyung-Tae (Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Jhang, Won-Kyoung (Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Jang, Wan-Sook (Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Ko, Jea-Kon (Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine) ;
  • Yun, Tae-Jin (Division of Pediatric Cardiac Surgery, Asan Medical Center, Ulsan University College of Medicine)
  • 심형태 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 장원경 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 장완숙 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 고재곤 (울산대학교 의과대학 서울아산병원 흉부외과) ;
  • 윤태진 (울산대학교 의과대학 서울아산병원 흉부외과)
  • Published : 2007.07.05
Download PDF
⟨ Previous Next ⟩

Abstract

Left ventricular inflow obstruction can be caused by a persistent left superior vena cava (SVC) and a dilated coronary sinus. A 31-day-old male infant with secondum atrial septal defect (ASD) and bilateral SVC underwent an operation for treating his uncontrollable congestive heart failure. The preoperative 2-dimensional echocardiography showed a normally sized mitral valve shrouded by a dilated coronary sinus. The operation consisted of pericardial patch closure of the ASD, coronary sinus unroofing and left SVC transfer to the right atrial auricle. The postoperative course was complicated by persistent chylothorax, which was controlled by thoracic duct ligation, He was discharged to home at the postoperative day 39. He has been followed up for 9 months and has displayed normal development.

좌측 상대정맥이 관상정맥동으로 유입되는 경우 늘어난 관상정맥동에 의한 좌심실 유입로 폐쇄가 드물게 나타날 수 있다. 이차공형 심방중격결손, 좌측 상대정맥에 동반된 심한 심부전증상을 보이는 31일된 남아에 대하여 수술을 시행하였다. 수술 전 초음파상 승모 판막의 크기는 정상이었으나 확장된 관상정맥동이 좌심실 유입로 위로 드리워져 기능적 협착을 유발하는 양상이었다. 수술은 확장된 관상정맥동을 절개하여 개방한 후 자가 심낭막을 이용하여 심방중격결손을 봉합하고, 좌측 상대정맥은 분리하여 우심방 돌기에 단단 문합하였다. 수술 후 환아의 좌측 흉강에 유미흉이 발생하여 술 후 31일째 흉관 결찰술을 시행하였으며, 이후 경과가 호전되어 술 후 39일째 퇴원하였다. 환아는 현재 수술 후 9개월째 관찰 중이며, 정상적인 성장을 보이고 있다.

Keywords

References

  1. Hutha JC, Smallhorn JF, Macartney FJ, et. al. Cross-sectional echocardiographic diagnosis of systemic venous return. Br Heart J 1982;48:388-403 https://doi.org/10.1136/hrt.48.4.388
  2. Di Bardino DJ, Fraser CD, Dickerson HA, et. al. Left ventricular inflow obstruction associated with persistent left superior vena cava and dilated coronary sinus. J Thorac Cardiovasc Surg 2004;127:959-62 https://doi.org/10.1016/j.jtcvs.2003.07.010
  3. Benatar A, Demanet H, Deuvaert FE. Left ventricular inflow obstruction due to a dilated coronary sinus mimicking cor triatriatum. Thorac Cardiovasc Surg 1999;47:127-8 https://doi.org/10.1055/s-2007-1013125
  4. Tirilomis T, Saldana FL, Dalichau H. Dilated coronary sinus mimicking posterior left ventricular aneurysm. Acta Cardiol 2001;56:199-200 https://doi.org/10.2143/AC.56.3.2005643
  5. Vargas FJ, Rozenbaum J, Lopez R, et al. Surgical approach to left ventricular inflow obstruction due to dilated coronary sinus. Ann Thorac Surg 2006;82:191-6 https://doi.org/10.1016/j.athoracsur.2006.02.062
  6. Cochrane AD, Marath A, Mee RBB. Can a dilated coronary sinus produce left ventricular inflow obstruction? An unrecognized entity. Ann Thorac Surg 1994;58:1114-6 https://doi.org/10.1016/0003-4975(94)90468-5
  7. Kreutzer C, Santiago G, Varon RF, et. al. Persistent left superior vena cava: an unusual cause of subdivided left atrium. J Thorac Cardiovasc Surg 1998;115:462-4 https://doi.org/10.1016/S0022-5223(98)70291-0