tailieunhanh - Báo cáo y học: "Persistent left vena cava incidentally recognized during subclavian vein catheterization"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Persistent left vena cava incidentally recognized during subclavian vein catheterization. | Bordes et al. Critical Care 2010 14 405 http content 14 1 405 CRITICAL CARE LETTER L_ Persistent left vena cava incidentally recognized during subclavian vein catheterization Julien Bordes Yves Asencio Erwan d Arranda and Philippe Goutorbe Central venous line insertion is a routine procedure in the intensive care unit. But intensivists should be aware of the possibility of rare anatomic variants. We report an 84-year-old patient who was admitted to the intensive care unit for respiratory distress due to Guillain-Barré syndrome. After intubation of the trachea a central venous catheter was inserted via the left subclavian vein. This was accomplished uneventfully with only one puncture. However the post-procedural chest x-ray showed an unusual left-sided paramediastinal course of the catheter Figure 1 . We evocated an arterial placement first but the transduced waveform and the blood gas samples were compatible with an intrathoracic vein placement. So we hypothesized that the patient could present with a persistent left superior vena cava LSVC . This diagnosis was confirmed by transoesophageal echography the injection of agitated saline via the right cubital vein resulted in opacification of the dilated coronary sinus prior to reaching the right atrium and right ventricle and this confirmed the anatomic variant of LSVC associated with the absence of a right superior vena cava. There were no other abnormalities concerning heart or great vessels. Persistent LSVC occurs in of the population and 5 to 10 of patients with congenital heart diseases. It usually drains into the right atrium through the coronary sinus and it is associated with an absent right superior vena cava in 20 of cases 1 . The diagnosis can be made by bedside transthoracic or transesophageal echocardiography 2 3 . Computed tomography can also be useful 4 . Persistent LSVC is not a contraindication to subclavian vein catheterization but can make difficult the attempt to place a .