Successful surgical intervention of total anomalous pulmonary venous drainage in the third decade of life

Uncommon variant of total anomalous pulmonary venous drainage in an infant with sudden death: a case report and review of the literature

Total anomalous pulmonary venous drainage (TAPVD) is encountered less frequently in infancy than various other congenital cardiac anomalies. We present a 4-week-old boy with a hitherto unreported variant of TAPVD who died suddenly soon after presentation to our emergency department. At autopsy, we found both pulmonary veins draining abnormally into the pulmonary artery and an atrial septal defect. We wish to emphasize that examination of the major vessels and their connections should be done in situ in all autopsies of unexpected deaths in infants and children, even if there were no symptoms and signs in the ante-mortem period and despite the clinical picture not being suggestive of TAPVD.

Surgical correction of total anomalous pulmonary venous return in an adult patient

Background

Total anomalous pulmonary venous return (TAPVR) is rare congenital heart disease. Most TAPVRs require surgical corrections in the neonatal period and survival to adulthood without surgical correction is extremely rare. Most untreated patients with large atrial septal defects and no pulmonary venous obstruction have pulmonary vascular damage from pulmonary over circulation.

Case presentation

44-year-old TAPVR patient admitted to our medical center. A snowman-shaped heart, including cardiomegaly and an increase in pulmonary blood flow, was seen in the chest X-ray. A large-sized (around 3 cm) atrial septal defect with dilated right atrium, right ventricle, and pulmonary artery was detected on echocardiography. Heart computed tomography was performed for further evaluation, and supra-cardiac type TAPVR without any obstructive lesion was identified.

Conclusions

TAPVR in an adult patient is extremely rare, and this patient was treated successfully with surgical correction and is doing well. A sinus rhythm and mild mitral valve regurgitation have remained during 2.5 years of outpatient follow-up.

Late diagnosis of total anomalous pulmonary venous drainage in a 5.5-month-old infant

A 5.5-month-old girl was admitted with non-specific signs and symptoms like dyspnea at rest, tachypnea, fatigue, low body weight and cyanosis on exertion. Physical examination revealed a barrel-shaped chest; no pathological sounds over the heart or both lung areas were detected. The above mentioned symptoms might suggest a circulatory problem. Echocardiography and computed tomography angiography were performed. These examinations revealed supracardiac type total anomalous pulmonary venous drainage. Echocardiographic signs of pulmonary hypertension and severe right ventricle overload were detected. Detailed analysis of both imaging examinations revealed atypical obstruction of the pulmonary venous return: narrowing of the proximal part of superior vena cava. An urgent surgery was performed, with no complications in the postoperative period. A follow-up echocardiography showed normalization of cardiac function and pulmonary pressure as well as normalization of flow profile within the superior vena cava. The paper presents a non-invasive diagnostic process in the described case, and discusses the causes of late diagnosis.