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- Persistent Left Superior Vena Cava Detected Incidentally after Pulmonary Artery Catheterization
- Hyun Jeong Lee, Namo Kim, Hyelin Lee, Jae Kwang Shim, Jong Wook Song
- Korean J Crit Care Med. 2015;30(1):22-26. Published online February 28, 2015
- DOI: https://doi.org/10.4266/kjccm.2015.30.1.22
- 8,660 View
- 80 Download
- 2 Crossref
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Abstract
PDF - We present a case of pulmonary artery catheter (PAC) placement through the right internal jugular vein, bridging vein and coronary sinus in a patient with previously unrecognized persistent left superior vena cava (LSVC) and diminutive right superior vena cava. A 61-year-old male patient was scheduled for mitral valve repair for regurgitation. Preoperative transthoracic echocardiography revealed dilated coronary sinus, but no further evaluations were performed. During advancement of the PAC, right ventricular and pulmonary arterial pressure tracing was observed at 50 and 60 cm, respectively. Transesophageal echocardiography ruled out intracardiac knotting and revealed the presence of the PAC in the LSVC, entering the right ventricle from the coronary sinus. Diminutive right superior vena cava was observed after sternotomy. The PAC was left in place for 2 days postoperatively without any complications. This case emphasizes that the possibility of LSVC and associated anomalies should always be ruled out in patients with dilated coronary sinus.
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Citations
Citations to this article as recorded by
- The Concept and Building of a Simulation Device to Check the Cardiac Output Measurement Through the Pulmonary Artery Catheter
Caio Francisco Ternus de Abreu, Bernardo Ternus de Abreu
Biomedical Materials & Devices.2024; 2(2): 968. CrossRef - Transthoracic Echocardiography–Guided Placement of a Pulmonary Artery Catheter in a Patient With a Known Persistent Left but Unknown Absent Right Superior Vena Cava
Jenna L. Leclerc, Raymond Clemes, Cristina Fuss, Conrad J. Macon, Peter M. Schulman
Circulation: Cardiovascular Imaging.2024;[Epub] CrossRef
- The Concept and Building of a Simulation Device to Check the Cardiac Output Measurement Through the Pulmonary Artery Catheter
- Continuous Infusion of Ketamine in Mechanically Ventilated Patient in Septic Shock with Status Asthmaticus
- Bon Nyeo Koo, Shin Ok Koh, Sung Yong Park, Jae Kwang Shim, Sung Sik Chon
- Korean J Crit Care Med. 2000;15(2):108-112.
- 2,072 View
- 43 Download
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Abstract
PDF
- Ketamine is well known for its analgesic, bronchodilating and sympathetic stimulating effect. Hence, it has been widely used for induction of patients with hypotension or asthma and also for analgesic and sedating purposes in the ICU. We presented a 62 year old female patient with ventilator support in septic shock with refractory asthma whom we managed successfully with continuous intravenous infusion of ketamine postoperatively in the ICU. The patient had a history of asthma but had been asymptomatic recently and was scheduled for an emergent explo-laparotomy under the diagnosis of acute panperitonitis. Before the induction of anesthesia, the patient was in septic shock but no wheezing could be auscultated. After the induction of general anesthesia and endotracheal intubation, wheezing was apparent in both lung fields with a high peak inspiratory pressure. Inotropics, vasopressors and bronchodilators were promptly instituted without any improvement of asthma and the patient had to be transferred to the ICU with intubated after the operation. Clinical symptoms of asthma continued throughout the first day despite using bronchodilators under mechanical ventilation but, after starting the IV infusion of ketamine, there were decrease in the peak inspiratory pressure and wheezing with a subsequent improvement in the arterial blood gas analysis findings. We could also achieve considerable analgesic and sedating effect without any decrease in the blood pressure. The patient's general physical status improved and weaning with extubation was successfully done on the 21st day and was transferred to the general ward on the 28th day.
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