左上大静脈遺残を合併した僧帽弁閉鎖不全症に対する弁形成術の1例

Surgical Experience of Mitral Valve Plasty in Patient with Persistent Left Superior Vena Cava；Report of a Case

はじめに　左上大静脈遺残（PLSVC）は大静脈系の先天性異常のうちもっとも多いが，ほかの先天性心疾患を伴わない場合はほとんどが無症状であるため，心臓大血管疾患の検査時に偶発的に指摘されることが多い．また，PLSVCを伴った症例の開心術は，体外循環時の脱血管挿入様式や心筋保護液の注入方法という問題が生じるため，術前の詳細な画像診断に基づいた手術戦略が重要である．われわれは僧帽弁閉鎖不全症（MR）の術前精査時にPLSVCを指摘された症例の僧帽弁形成術（MVP）を経験したので，文献的考察とともに報告する．

A 45-year-old man diagnosed with severe mitral regurgitation was admitted to our hospital for surgical treatment. Preoperative computed tomographic imaging revealed a persistent left superior vena cava. At operation, cardiopulmonary bypass was established with ascending aortic and bicaval cannulation. In addition to 2 venous cannulas, we directly cannulated to the left superior vena cava for sufficient venous drainage. Mitral valve plasty consisted of triangular resection of P2 segment was performed through the right side left atriotomy. Postoperative course was uneventful and echocardiography 3 months after the operation showed trivial mitral regurgitation. Precise preoperative evaluation concerning the persistent left superior vena cava should be mandatory for appropriate management of cardiopulmonary bypass.