右上大静脈欠損，左上大静脈遺残を伴う僧帽弁閉鎖不全症に対する弁形成術の1例

Valve Repair for Mitral Regurgitation with Absent Right Superior Vena Cava and Persistent Left Superior Vena Cava；Report of a Case

はじめに　右上大静脈欠損兼左上大静脈遺残はまれな体静脈還流異常であり，開心術や経静脈ペースメーカ電極挿入時などには工夫を要する．われわれは上記異常に加えて心不全症状を伴う僧帽弁閉鎖不全（MR）を合併した症例を経験したので，術前造影所見および術中所見を呈示し，文献的考察も加えて報告する．

A 73-year-old male was suffering from severe mitral regurgitation due to P3 torn chorda and moderate tricuspid regurgitation with absent right superior vena cava （RSVC） and persistent left superior vena cava （PLSVC）. The patient successfully underwent mitral valve repair with 2 artificial chords （Gore-Tex CV3）and Cosgrove band 32 mm, tricuspid annuloplasty with Cosgrove band 34 mm, and maze procedure. Cardiopulmonary bypass was established with aortic and double caval cannulation. The PLSVC was directly cannulated with an L-shaped cannula at the left of the main pulmonary artery. We believe that it should be advantageous, because it would neither impinge on operative view nor cause damage to sinus node tissue around the coronary sinus. To our knowledge, there have been only 8 cases of open heart surgery with such systemic venous drainage anomaly so far in Japan.