Diagnosis and management of partial anomalous pulmonary venous connection. A review of 28 pediatric cases

Video assisted thorascopic assisted correction of left partial anomalous pulmonary venous connection: one case report

INTRODUCTION

The left partial anomalous pulmonary vein connection is a rare congenital heart disease, especially with intact atrial septum. Now we reported a case of the left superior pulmonary vein drainage to left innominate vein through a vertical vein, and corrected with video assisted thoracoscopy.

CASE PRESENTATION

A-59-years old man diagnosed left anomalous partial pulmonary vein connection with presentation of short breathiness and palpation, and diagnosed with computer tomography pulmonary angiography. The operation was carried out under video assisted thoracoscopy with one manipulation incision and one observational incision, the vertical vein was dissected and anastomosis with left atrial appendage. The patients recovered smoothly and postoperative CTPA showed anastomosis ostium was unobstructed.

CONCLUSION

The left lateral thoracotomy and video assisted thoracoscopic surgery is a feasible for correction of left PAPVC with intact interatrial septum without using CPB.

Transcatheter implantation of covered stents serving as extravascular conduits-Proof of a CT-based approach in three cases

BACKGROUND

Covered stents perform similar to surgically implanted conduits, although the stents work inside of vessels. We present a computed tomography (CT)-based workflow for the implantation of covered stents as extravascular conduits.

METHODS

We selected three different use cases: 1. Connecting a left-sided partially anomalous drainage of a pulmonary vein to the left atrium. 2. Bypassing an outgrown Dacron conduit in aortic recoarctation. 3. Re-directing hepatic venous blood to the left lung in a Fontan patient with heterotaxy, connecting the innominate vein to the right pulmonary artery like a right-sided cavopulmonary connection. By postprocessing and analyzing CT scans for planning and by the use of long needles under biplane fluoroscopy for the realization of the procedure, we projected and performed the exit of a long needle out of a vessel, the re-entering of a target vessel, and the bridging of the extravascular distance by implantation of covered stents.

RESULTS

In all three cases, the covered stents were placed successfully, connecting vessels of 15-50 mm distance from each other with very good hemodynamic results. In one case, two stents were placed consecutively, overlapping each other to accomplish an exact fitting at the connection sites to the native vessels.

Lung cancer with partial anomalous pulmonary venous connection in a different lobe: a case report

Background

Anomalous pulmonary venous connection (APVC) is a congenital malformation in which the pulmonary veins connect to the systemic venous system but not to the left atrium. APVC can be classified as total or partial (PAPVC). PAPVC is rare among surgical patients with lung cancer, and most cases are detected incidentally during surgery. We herein report a patient with lung cancer in whom PAPVC was diagnosed before surgery, which made it difficult to determine the surgical procedure.

Case presentation

A 71-year-old man was followed-up as an outpatient after surgery for renal cell carcinoma. Chest computed tomography showed a 22-mm nodule in the right lower lobe and PAPVC in the right upper lobe. He was diagnosed with lung adenocarcinoma (cT1cN0M0 stage IA3) and scheduled for surgery. Preoperative catheterization showed a pulmonary to systemic flow ratio (Qp/Qs) of 1.64 and mean pulmonary artery pressure (MPAP) of 16 mmHg. Surgical repair of PAPVC is indicated when a patient is symptomatic and has a Qp/Qs ≥1.5–2.0. The patient was scheduled for right lower lobectomy, but postoperative worsening of right heart strain was considered. Concomitant PAPVC repair was therefore considered, but he had no atrial septal defect and was asymptomatic; therefore, PAPVC treatment was considered unnecessary. However, we planned to perform concomitant PAPVC repair if his circulatory dynamics worsened during surgery or if his MPAP exceeded 25 mmHg. His MPAP was 20 mmHg and his circulatory dynamics remained stable, and right lower lobectomy was therefore completed. His postoperative course was favorable. Follow-up catheterization at 6 months showed a Qp/Qs of 1.19 and MPAP of 18 mmHg, with no evidence of increased right heart strain. There was no evidence of right heart failure or recurrence of lung cancer at last follow-up at 18 months after surgery.

Conclusions

We present a case of right lower lung cancer complicated by PAPVC in the right upper lobe. This case suggests that concomitant repair of PAPVC in the right upper lobe may not be necessary when performing right lower lobectomy, although the patient’s Qp/Qs and MPAP should be considered.

Lobectomy with bronchoplasty and pulmonary arterial angioplasty for lung cancer after correction of contralateral partial anomalous pulmonary venous connection

Background

There have been few reports on surgically treated primary lung cancer accompanied by contralateral partial anomalous pulmonary venous connection (PAPVC). In such cases, repair of the PAPVC might be necessary to avoid postoperative right-heart failure due to the increased flow of the left-to-right shunt.

Case presentation

We herein report a case of lung adenocarcinoma treated by left-upper lobectomy with bronchoplasty and pulmonary arterial angioplasty after induction chemoradiation therapy followed by surgical correction of the PAPVC in the right-upper lobe. The patient is alive without recurrence of lung cancer or any symptoms of heart failure 17 months after pulmonary resection.

Conclusion

When considering performing major pulmonary resection for lung tumor, thoracic surgeons should pay close attention to the presence of a PAPVC not only on the ipsilateral side of the lung tumor, but also the contralateral side, although it is a rare phenomenon.

Partial anomalous pulmonary venous drainage in patients presenting with suspected pulmonary hypertension: A series of 90 patients from the ASPIRE registry

Background and objective

There are limited data regarding patients with PAPVD with suspected and diagnosed PH.

Methods

Patients with PAPVD presenting to a large PH referral centre during 2007–2017 were identified from the ASPIRE registry.

Results

Ninety patients with PAPVD were identified; this was newly diagnosed at our unit in 71 patients (78%), despite 69% of these having previously undergone CT. Sixty‐seven percent had a single right superior and 23% a single left superior anomalous vein. Patients with an SV‐ASD had a significantly larger RV area, pulmonary artery and L‐R shunt and a higher % predicted DL_CO (all P < 0.05). Sixty‐five patients were diagnosed with PH (defined as mPAP ≥ 25 mm Hg), which was post‐capillary in 24 (37%). No additional causes of PH were identified in 28 patients; 17 of these (26% of those patients with PH) had a PVR > 3 WU. Seven of these patients had isolated PAPVD, five of whom (8% of those patients with PH) had anomalous drainage of a single pulmonary vein.

Conclusion

Undiagnosed PAPVD with or without ASD may be present in patients with suspected PH; cross‐sectional imaging should therefore be specifically assessed whenever this diagnosis is considered. Radiological and physiological markers of L‐R shunt are higher in patients with an associated SV‐ASD. Although many patients with PAPVD and PH may have other potential causes of PH, a proportion of patients diagnosed with PAH have isolated PAPVD in the absence of other causative conditions.

PAPVD was frequently missed in patients presenting with suspected PH. L‐R shunt was higher in patients with associated ASD. Although patients may have other potential causes of PH, some patients with PAH have isolated PAPVD without other causative conditions.

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Partial anomalous pulmonary venous connection associated with hemoptysis: A case report

RATIONALE

Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital anomaly characterized by the failure of fusion of embryologic pulmonary venous system with left atrium.

PATIENT CONCERNS

A 45-year-old male patient with PAPVC who was hospitalized because of mild hemoptysis. Images showed the anomalous vein originated from the left upper pulmonary vein and flowed into the left brachiocephalic vein. No other underlying causes for hemoptysis were detected.

DIAGNOSIS

After multi-disciplinary discussion, the patient was diagnosed as PAPVC of left upper pulmonary vein draining into the left brachiocephalic vein with intact atrial septum.

INTERVENTIONS

Although surgical correction of PAPVC was feasible, left upper lobectomy was performed as the definitive treatment for both hemoptysis and PAPVC.

OUTCOMES

The patient had an uneventful postoperative hospital course and was followed up for nearly 2 years without recurrence of hemoptysis.

LESSONS

PAPVC is associated with atrial septal defect in 80% to 90% of cases while isolated PAPVC with intact atrial septum is an extremely rare entity. We present a rare isolated PAPVC patient with hemoptysis. To our best knowledge, PAPVC associated with hemoptysis has never been reported before.

Left sided PAPVC with intact IAS-Surgically managed with vertical vein anastomosis to LA appendage: A rare case report

INTRODUCTION

Partial anomalous pulmonary venous connection (PAPVC) is a rare entity. Only 10% of these are left sided. An intact atrial septum is further uncommon.

PRESENTATION OF CASE

We present a case of left sided PAPVC with no atrial septal defect (ASD), who presented with effort intolerance and an unremarkable physical examination. Computed tomography pulmonary angiography (CTPA) confirmed the primary diagnosis as suggested by an initial 2-D echocardiography, and aided in better understanding of the anatomy.

CONCLUSION

Patient underwent successful surgery through a simple & reproducible technique of anastomosis of vertical vein to left atrial appendage. Patient recovered uneventfully and was discharged on day 10.

A Partial Anomalous Pulmonary Venous Connection in a Severely Symptomatic Patient, Is Surgery Always Recommended?

Partial anomalous pulmonary venous connection (PAPVC) is a rare cardiac anomaly occurring when a pulmonary vein drains into the right atrium, coronary sinus or a systemic vein creating a left-to-right shunt. Symptoms develop from right-sided fluid overload and pulmonary vascular disease. We report a rare case of a severely symptomatic patient with an incidentally discovered PAPVC in the setting of underlying severe pulmonary hypertension from multifactorial severe restrictive lung disease. Despite his worsening symptoms, a multi-disciplinary meeting decided against surgical intervention. Nine months after the decision was made, the patient showed no signs or symptoms of clinical deterioration. Prior studies recommend surgery for PAPVCs with evidence of right ventricular dilation, mild-to-moderate tricuspid regurgitation, or early stages of pulmonary vascular disease. However, our case demonstrates how decision making should consider the shunt’s contribution to the overall clinical picture and underlying comorbidities. If a decision is made to defer surgical intervention, strict follow up and repeat re-evaluations for possible risk re-stratification and surgery reconsideration are warranted.

Transcatheter therapy of partial anomalous pulmonary venous connection with dual drainage and coarctation of the aorta in a single patient

A 12-year-old boy was found to have aortic coarctation and a partial anomalous pulmonary venous connection. Historically, multiple cardiac pathologies, such as in the present case, required a surgical approach. We describe transcatheter treatment of the coarctation with a stent and occlusion of the partial anomalous pulmonary venous connection with an Amplatzer vascular plug in a single patient without complications.

Vena cava anomalies in thoracic surgery

BACKGROUND

Vena cava anomalies are a rare group of anatomical variations due to an incorrect development of the superior or inferior vena cava during fetal life. They generally show no clinical relevance and the diagnosis is done due to the association with congenital heart diseases in most of cases. However, preoperative identification of these anomalies is mandatory for surgeons to proper surgical planning. If not recognized, lethal complications may occur, as already reported in literature.

CASE PRESENTATION

We report a case series of three different unidentified vena cava anomalies in patients undergoing lung resection. These unrecognized anomalies led to minor complications in two cases and required an accurate intraoperative evaluation in another. A careful retrospective evaluation of preoperative radiological images showed the anomalies.

CONCLUSIONS

A careful evaluation of the vena cava anatomy at pre-operative imaging is mandatory for thoracic surgeons to properly plan the surgery and avoid complications.

Partial anomalous pulmonary venous connection in a dog

A 2-year-old male intact Belgian Malinois was presented for exercise intolerance. A grade III/VI left basilar systolic murmur was detected. Echocardiography revealed moderate right atrial and ventricular dilation and increased pulmonic outflow velocity. Thoracic radiographs showed right heart enlargement and a dilated caudal vena cava. In addition, on the left lateral projection, an enlarged aberrant right cranial pulmonary lobar vein was suspected to be diverging ventrally from the course of the right cranial lobar bronchus and inserting more ventrally than normal in the region of the right atrium. A left-to-right pulmonary vascular shunt was suspected, and the patient underwent further diagnostics under general anesthesia. An agitated saline study was positive, suggestive of a concurrent right to left shunt. A right heart catheterization was performed. Angiography was inconclusive. Oximetry testing revealed an increase in oxygen saturation within the right atrium at the level of the caudal cava supportive of a left-to-right shunt in this region. Computed tomography angiography revealed a large single pulmonary vein that anomalously entered into the caudolateral aspect of the right atrium (left-to-right shunt) and was suspicious for a small arteriovenous malformation between the right caudal pulmonary artery and the right pulmonary vein returning to the left atrium (right to left shunt). The patient was diagnosed with a partial anomalous pulmonary venous connection and a possible arteriovenous malformation.

Modified Warden procedure for partial anomalous pulmonary venous return to the superior vena cava

BACKGROUND

We report the long-term outcomes of our modified Warden cavoatrial technique, originally reported in 2010, for the treatment of anomalous pulmonary veins, which insert into the superior vena cava (SVC).

METHODS

This study was conducted between 2007 and 2015 in 26 patients (18 females, eight males) with a mean age of 22 years (range, 4-70 years). Twenty-four patients had a sinus venosus atrial septal defect and one patient had two partial anomalous pulmonary venous connections to the SVC. Two patients with persistent left SVC underwent right SVC division without reimplantation.

RESULTS

There were no short- or long-term mortalities. The mean follow-up was 4.6 years (range, three months to eight years). All patients had unobstructed caval and pulmonary venous flow and no long-term arrhythmias.

CONCLUSIONS

The modified cavoatrial anastomosis technique has shown excellent results with unobstructed pulmonary and systemic venous flow without long-term arrhythmias.

Thoracoscopic lobectomy for lung cancer in a patient with a partial anomalous pulmonary venous connection: a case report

Background

A partial anomalous pulmonary venous connection is a rare congenital defect in which blood from the pulmonary vein is returned to the right atrium. Asymptomatic patients with a partial anomalous pulmonary venous connection with a small left-to-right shunt do not require surgical treatment. If such patients require a major lung resection, the surgical procedure could precipitate fetal right heart failure if the anomalous venous connection remains uncorrected.

Case presentation

A 59-year-old man was found to have an abnormal shadow on chest roentgenogram. Chest computed tomography imaging showed a mass in the right upper lobe. At the same time, we incidentally found an anomalous vessel. We diagnosed the abnormality as a partial anomalous pulmonary venous connection. Because the mass may have been lung cancer, a right upper lobectomy was performed using video-assisted thoracoscopic surgery. The right upper lobe vein drained into the superior vena cava. The anomaly was not corrected and the surgery was successful. His postoperative course was uneventful without cardiac failure.

Conclusions

Before performing a major lung resection, surgeons should be aware of this rare anomaly and carefully interpret clinical images of all pulmonary veins.

Pulmonary Hypertension Secondary to Partial Anomalous Pulmonary Venous Return in an Elderly

Background. Partial anomalous pulmonary venous return (PAPVR) is an uncommon congenital abnormality, which may present in the adult population. It is often associated with sinus venosus defect (SVD). The diagnosis and therapy for this condition may be challenging. Case Presentation. We describe a case of an elderly woman who presented with NYHA Class IV dyspnea and was suspected to have symptomatic pulmonary hypertension. She was later found to have anomalous right upper pulmonary vein return to the superior vena cava and associated SVD with bidirectional shunting. Therapeutic options were discussed and medical management alone with aggressive diuresis and sildenafil was adopted. Follow-up visits revealed success in the planned medical therapy. Conclusions. PAPVR is a rare congenital condition that may present during late adulthood. The initial predominant left-to-right shunting associated with this anomaly may go undetected for years with the gradual development of pulmonary hypertension and right heart failure due to right heart volume overload. Awareness of the condition is important, as therapy is time-sensitive with early detection potentially leading to surgical therapy as a viable option.

Never too old for congenital heart disease: sinus venosus atrial septal defect with anomalous pulmonary venous return in an octogenarian

We report a rare case in an 86-year-old woman with symptoms of exercise intolerance, fatigability, worsening lower extremity edema, and normal ejection fraction on echocardiographic examination who presented with a presumptive diagnosis of heart failure with preserved ejection fraction (HFpEF). Hemodynamic studies revealed that she had normal left-sided filling pressures, mildly elevated pulmonary pressures with normal pulmonary vasculature resistance, and evidence of right ventricular dysfunction. Significant shunting was also detected with a step-up blood oxygen saturation from superior vena cava to right atrium and a calculated pulmonary-to-systemic blood flow ratio of 3.9. Contrast-enhanced multidetector cardiac computed tomography confirmed the presence of a patent foramen ovale, a sinus venosus atrial septal defect, and 3 anomalous pulmonary venous communications to the right atrium and superior vena cava. We hereby present one of the oldest diagnosed cases of sinus venosus defect with anomalous pulmonary venous return as a rare cause of recent-onset dyspnea, volume overload, and functional intolerance in an 86-year-old woman with an initial misdiagnosis of HFpEF.

Ipsilateral partial anomalous pulmonary venous connection in right lung cancer with absent right upper lobe

A partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly. This report documents the case of a 48-year-old man with PAPVC which was incidentally discovered with right lung cancer and absence of right upper lobe. Right pneumonectomy was successfully performed, and the patient had an uneventful postoperative course. Asymptomatic PAPVC without septal defect is extremely rare. If the PAPVC is located in a different lobe, a pulmonary resection for lung cancer would precipitate an adverse outcome without a correction of the PAPVC. Surgeons should therefore be cautious regarding the potential existence of a PAPVC when a patient undergoes surgical procedures.

Surgery for partial anomalous pulmonary venous connections: modification of the warden procedure with a right atrial appendage flap

Background

Surgical repair of a partial anomalous pulmonary venous connection (PAPVC) to the superior vena cava (SVC) may be complicated by sinus node dysfunction or SVC obstruction. We modified the Warden procedure by using a right atrial auricular flap to decrease the occurrence of these complications.

Methods

Between February 2005 and July 2012, 10 consecutive patients underwent a modified Warden procedure to correct PAPVC. The median patient age was 5.7 years. Eight patients (80%) had an atrial septal defect. To surgically correct the PAPVC, we made a U-shaped incision on the right atrial appendage and sutured the flap to the posterior wall of the SVC. The anterior wall was reconstructed with various patch materials.

Results

No early or late deaths occurred, nor did any patient require early or late reoperation for SVC or pulmonary venous obstruction. No new arrhythmias appeared during follow-up, which was complete in all patients (mean, 29.5 months).

Conclusion

Our modification of the Warden procedure seems to be effective and safe. This technique may lower the risk of SVC obstruction, pulmonary venous obstruction, and sinus dysfunction.

Pulmonary resection of lung cancer in a patient with partial anomalous pulmonary venous connection

We report a case of a 64-year-old man in whom a partial anomalous pulmonary venous connection (PAPVC) was found before right lower lobectomy for lung cancer. In addition to lung cancer, there was a right superior pulmonary vein that drained into the superior vena cava (SVC). There was a concern of right ventricular heart failure resulting from increased left-to-right shunt flow after lobectomy. Therefore cardiac catheterization was performed to calculate the pulmonary-to-systemic flow rate in the presence of blocked blood flow to the lower lobe pulmonary artery. As a result, we successfully performed lobectomy without correcting the PAPVC.

Partial anomalous pulmonary venous return and atrial septal defect in adult patients detected with 128-slice multidetector computed tomography

The present series describes a group of adults with left-to-right shunts including partial anomalous pulmonary venous return (PAPVR) and/or an atrial septal defect (ASD) evaluated with ECG-gated 128-slice multidetector computed tomography (MDCT). PAPVR is defined as a left-to-right shunt where one or more, but not all, pulmonary veins drain into a systemic vein or the right atrium. PAPVR involving the right upper pulmonary vein can be associated with a sinus venosus ASD. The presence, course, number of anomalous veins and associated cardiovascular defects can be reliably observed by 128-slice MDCT angiography.

Anomalous left superior pulmonary venous connection with intact interatrial septum

Partial anomalous pulmonary venous connection (PAPVC) with intact interatrial septum is an uncommon congenital anomaly, while isolated left pulmonary venous connection with intact interatrial septum is rare. In this report, a 5-year-old girl with chief complains of mild short breath after exercise was diagnosed of anomalous connection between left superior pulmonary vein (LSPV) and left innominate vein by transthoracic echocardiography (TTE) that was confirmed by 3D cardiac CT scanning.

Multimodality imaging of anomalous pulmonary veins

Partial anomalous pulmonary venous connection (PAPVC) is an extremely rare congenital condition where one or more of the pulmonary veins are connected to the venous circulation. Although initially suspected with unexplained right ventricular enlargement on transthoracic echocardiography (TTE), cardiac MRI is able to delineate the anatomical variant. We present a case of a 65-year-old male diagnosed with left sided PAPVC using multimodality cardiac imaging.

An unusual manifestation of left partial anomalous pulmonary venous connection

A 68-year-old male patient had aortic valve replacement for aortic valve endocarditis. The central line (left) position looked abnormal on chest X-ray. Contrast studies confirmed left sided partial anomalous pulmonary venous connection.

Unusual case of left partial anomalous pulmonary venous connection with successful surgical management

We describe a case of left-sided partial anomalous pulmonary venous connection diagnosed in the setting of a respiratory illness affecting the right lung, which presumably elevated pulmonary pressures and worsened right-to-left shunting. The anatomical configuration appears to be highly unusual in this case, with separate supracardiac connections of the left upper pulmonary vein (LUPV) to a vertical vein (draining to the innominate vein) and the left lower pulmonary vein to the azygos vein. Successful surgical repair was undertaken with direct anastomosis of the LUPV to the left atrial appendage and creation of an intra-superior vena cava baffle to redirect azygos vein flow to the left atrium.

Diagnostic tools in the preoperative evaluation of children with anomalous pulmonary venous connections

Pulmonary venous abnormalities are generally diagnosed by echocardiography and often confirmed by cardiac catheterization. Although angiography has been the gold standard for evaluation it carries certain inherent risks, especially in small and sick infants. In this study we retrospectively assessed the utility of magnetic resonance angiography (MRA) and computed tomography angiography (CTA) in the evaluation of pulmonary venous abnormalities in pediatric patients. The results were compared with operative findings. We reviewed nine patients with total APVC and four with partial APVC. Twelve patients were infant (age range: 1 day to 8 months) and the other was 16 years old. MRA and/or CTA clearly visualized the anomalous drainage of pulmonary veins in all patients. Cardiac catheterization was performed five patients with one total anomalous pulmonary venous connection and four with partial anomalous pulmonary venous connection. Ten patients were operated on. Diagnoses of patients were confirmed by operative findings. In Conclusions, MR and CT angiography allow detailed and comprehensive evaluation of the APVC and are good diagnostic modalities for use in the preoperative assessment of the anomaly in pediatric patients.

Visualization of congenital thoracic vascular anomalies using multi-detector row computed tomography and two- and three-dimensional post-processing

Anomalies of the vascular system are caused by false embryogenesis and are therefore present from birth. Single-detector row spiral computed tomography angiography (CTA) and multi-detector row computed tomography angiography (MDCTA) have gained increasing importance in the non-invasive assessment of vascular pathologies and replace conventional angiography in many cases. High-resolution volumetric datasets that are acquired during a single breath-hold give the possibility of two- (2D) and three-dimensional (3D)-post-processing. Due to post-processing, even complex vascular malformations are visualized in an understandable way. Furthermore, CTA, in contrast to conventional angiography, depicts not only the vascular structures but also allows assessment of the surrounding anatomical structures. We present cases of rare congenital anomalies of the thoracic vessels using MDCT with special respect to 2D- and 3D-post-processing.

Magnetic resonance imaging is the diagnostic tool of choice in the preoperative evaluation of patients with partial anomalous pulmonary venous return

BACKGROUND

Diagnosis of partial anomalous pulmonary venous return is usually suspected by echocardiography and often confirmed by cardiac catheterization. Magnetic resonance imaging is a powerful non-invasive diagnostic tool that can give accurate insight on systemic and pulmonary veins, cardiac anatomy and physiopathology.

AIM

To test the diagnostic accuracy of magnetic resonance in patient with suspected partial anomalous pulmonary venous return.

CASE PRESENTATION

Twenty consecutive patients (10 male, mean age: 27+/-20 years) with suspected partial anomalous pulmonary venous return underwent a magnetic resonance study comprehensive of Gadolinium-enhanced three-dimensional magnetic resonance angiography and phase-velocity-contrast in order to evaluate pulmonary and systemic venous anatomy and QP/QS. In 14 of them a cardiac catheterization was also performed. Anatomy findings and QP/QS result of both exams were compared. Sixteen patients underwent surgical correction. In the other four patients with QP/QS<1.5, surgical correction was not indicated according to the literature (1). Among patients who had both magnetic resonance and cardiac catheterization (14 patients) anatomical findings were concordant in 12 of them. In all operated patients, surgical findings were concordant with MRI report. There was a good correlation between magnetic resonance and cardiac catheterization QP/QS evaluation (mean value 2.23 and 2.4, respectively).

CONCLUSION

In patients with suspected anomalous pulmonary venous return, magnetic resonance provides a comprehensive evaluation of pulmonary venous return and the amount of shunt, overcoming most of the limitations of echocardiography. Therefore magnetic resonance is a powerful diagnostic tool for indicating therapeutic management and surgical strategies for this group of patients, and can be considered a non-invasive alternative to cardiac catheterization.

Left Pneumonectomy for Lung Cancer After Correction of Contralateral Partial Anomalous Pulmonary Venous Return

We report the successful treatment of a 48-year-old man with left lung cancer and contralateral partial anomalous pulmonary venous return (PAPVR). He was found to have an abnormal shadow on a regular checkup. Sputum cytology revealed squamous cell carcinoma. Chest computed tomography showed not only a left hilar mass but also showed that his right superior pulmonary vein was draining into the high portion of the superior vena cava. In the presence of the right partial anomalous pulmonary venous return, it was believed that left pneumonectomy would cause serious postoperative heart failure due to an increase in the left-to-right shunt. Therefore his partial anomalous pulmonary venous return was corrected first under cardiopulmonary bypass, and 3 weeks later he underwent successful radical left pneumonectomy.

Look before you close: Atrial septal defect with undiagnosed partial anomalous pulmonary venous return

The growing and continued success of percutaneous closure of atrial defects is related to its high benefit-to-risk ratio in appropriately selected patients. The following case illustrates a previously undocumented danger, namely, the potential for incomplete correction. A thorough transesophageal examination performed at the time of the planned atrial defect closure suggested the presence of a partial anomalous pulmonary vein insertion, which was then appropriately documented and the incomplete closure was averted.

An unusual case of partial anomalous pulmonary venous drainage

We report a case of partial anomalous pulmonary venous drainage where the left upper and lower pulmonary veins drain into a separate posterior left atrial (LA) chamber before continuing as a vertical ascending vein. The vertical vein then joins the left innominate vein, which eventually drains into a normal right-sided superior vena cava. There was no fenestration or communication between this posterior chamber and the true LA. The true LA contained the fossa ovale and LA appendage. The right upper and lower pulmonary veins drain normally into the true LA. To our knowledge, this is the first case where the left upper and lower pulmonary veins drain into a separate posterior LA chamber before continuing into a vertical vein. The diagnosis was initially made with transesophageal echocardiography and confirmed by magnetic resonance imaging. The patient later underwent successful corrective operation.