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題 名 | Aberrant Infrarenal Inferior Vena Cava as a Hindrance to Percutaneous Transvenous Mitral Valvuloplasty in a Patient with Mitral Stenosis: Case Report=左側腎下段下腔靜脈阻礙僧帽瓣狹窄病人之經皮僧帽瓣氣球擴張術:病例報告 |
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作 者 | 楊伯義; 陳銘賢; 林芬瓊; | 書刊名 | 長庚醫學 |
卷 期 | 22:3 1999.09[民88.09] |
頁 次 | 頁530-535 |
分類號 | 415.3161 |
關鍵詞 | 僧帽瓣狹窄; 下腔靜脈; Mitral stenosis; Inferior vena cava; |
語 文 | 英文(English) |
中文摘要 | 一位44歲僧帽瓣狹窄之女性,入院接受心導管檢查並預作經皮經靜脈氣球擴張術 (PTMC)之治療;其肺靜脈楔行壓為25 mmHg,平均左心房與左心室舒張其壓力差為 20.3mmHg,心輸出量指數為1.80 L/min/m ,而僧帽瓣開口面積為0.7cm ,在完成診斷性 心導管檢查後,心房中隔穿刺利用導引線受阻於下腔靜脈(IVC)中段。我們使用-7F Bermann 導管探查其IVC之途徑。因而發現IVC繞行於第四、五腰椎左緣而且在腹腔主動脈左側。 而在第三腰椎上緣回歸脊椎之右側。幾經考慮Brockenbrough長針無法通過曲繞的IVC而且 有造成該血管破裂之虞,因而心房中膈穿刺術以及後續之PTMC被迫取消。該病人改接受 外科的開放式僧帽瓣擴張術治療。 |
英文摘要 | Cardiac catheterization and percutaneous transvenous mitral commissurotomy using the Inoue technique were attempted in a 44-year-old woman with mitral stenosis. The pulmonary arterial wedge pressure was 25 mmHg, mean transmitral diastolic pressure gradient 20.3 mmHg, cardiac index 1.80 L/min/m , and mitral valve area 0.70 cm . After the diagnostic catheterization, the guide wire for the transseptal procedure was checked in the middle of the inferior vena cava (IVC). A 7- French end-holed Bermann catheter was then used to detect the course of the IVC. It was found that the IVC coursed along the left border of the 4th and 5th lumbar vertebrae, to the left of the abdominal aorta. At the upper border of the third lumber vertebra, the IVC returned to the right side of the vertebra. In consideration of the inability to pass the Brockenbrough needle through the detoured infrarenal IVC and the risk of rupturing the vessel, the transseptal procedure and attempted percutaneous transvenous mitral commissurotomy were aborted. Therefore, the patient underwent open mitral commissurotomy instead. |
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