左下大静脈半奇静脈結合を伴う肝下部下大静脈欠損の成人患者における僧帽弁形成術の1例

Mitral Valvuloplasty in a Patient with Left Inferior Vena Cava with Hemiazygos Continuation：Report of a Case

はじめに　下大静脈（IVC）の先天性異常は，CTの発展により報告される頻度が増えてきている．われわれは肝下部IVC欠損，hemiazygos continuationを伴う左側IVCと冠状静脈洞に流入する左側上大静脈（PLSVC）を認める僧帽弁閉鎖不全症（MR）患者に僧帽弁形成術を施行した1例を経験したので報告する．

Congenital anomalies of the inferior vena cava have been reported more frequently with the development of computed tomography （CT）. Here, we report a case of a 70-year-old woman who was diagnosed with heterotaxy syndrome and was suitable for mitral valvuloplasty. The diagnosis was made based on the preoperative contrast-enhanced CT findings of the left inferior vena cava with hemiazygos continuation into the coronary sinus and absence of the hepatic segment of the right inferior vena cava. The patient successfully underwent mitral valvuloplasty under cardiac arrest and cardiopulmonary bypass with drainage from the right superior vena cava and left femoral vein. The patient had an uneventful postoperative course and was discharged on postoperative day 13. In conclusion, the accurate preoperative diagnosis of cardiac and vascular anatomy is essential for developing effective surgical strategies in cardiac procedures, especially when a cardiopulmonary bypass is required.