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Jin C, Wu Y, Wang Z, Liu X, Wang Q. Isolated Partial Anomalous Pulmonary Veins: A 10-Year Experience at a Single Center. J Surg Res 2024; 298:63-70. [PMID: 38574463 DOI: 10.1016/j.jss.2023.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 11/29/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Isolated partial anomalous pulmonary venous connection (PAPVC) is difficult to diagnose, and surgical indications remain controversial. We reviewed 10 y of isolated PAPVC cases. METHODS The data of patients with isolated PAPVC admitted to the Anzhen Congenital Heart Disease Department from 2010 to 2019 were reviewed retrospectively. RESULTS Thirty patients, aged between 4 mo and 32 y, were included in this study. Significant correlations were found between the right ventricle (RV), end-diastolic dimension Z-score (RVED-z) and age (r = 0.398, P = 0.03), and between estimated pulmonary pressure and age (r = 0.423, P = 0.02). However, no significant correlations were found between the RVED-z and the number of anomalous pulmonary veins (r = 0.347, P = 0.061), between estimated pulmonary pressure and the RVED-z (r = 0.218, P = 0.248), and between estimated pulmonary pressure and the number of anomalous veins (r = 0.225, P = 0.232). Transthoracic echocardiography (TTE) confirmed 90% of isolated PAPVC cases. Surgical repair was performed in 29 patients with RV enlargement, persistent low weight, pulmonary hypertension, or respiratory symptoms. Among the surgical patients, nine had elevated pulmonary pressure before surgery, which decreased postoperatively; no mortality or reintervention was observed. The mean duration of echocardiographic follow-up was 1.9 y. CONCLUSIONS TTE is recommended for routine assessments, and further clarification can be obtained with computed tomography when TTE proves inconclusive for diagnosis. Transesophageal echocardiography and computed tomography are further recommended for adult patients if TTE fails to provide clear results. PAPVC should be considered as an underlying cause when unexplained RV enlargement is observed. Surgery is recommended for patients with RV enlargement, pulmonary hypertension, or respiratory symptoms.
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Affiliation(s)
- Can Jin
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Yongtao Wu
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Zhiyi Wang
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Xiaoran Liu
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China
| | - Qiang Wang
- Pediatric Cardiothoracic Department, Beijing An Zhen Hospital Affiliated with Capital University of Medical Sciences, Beijing, China.
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Rizzo M, Ait-Ali L, Federici D, Festa P, Piagneri V, Landra F, Cameli M, Montesi G. Surgical repair of partial anomalous pulmonary venous connection in adulthood: A 4-dimensional flow magnetic resonance imaging postoperative evaluation. JTCVS Tech 2023; 22:208-211. [PMID: 38152192 PMCID: PMC10750877 DOI: 10.1016/j.xjtc.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 08/23/2023] [Accepted: 09/16/2023] [Indexed: 12/29/2023] Open
Affiliation(s)
- Martina Rizzo
- Cardiac Surgery Unit, Department of Thoracic and Cardiovascular Disease, Santa Maria alle Scotte Hospital, University of Siena, Siena, Italy
| | - Lamia Ait-Ali
- Institute of Clinical Physiology, CNR, Monasterio Foundation, Massa, Italy
| | - Duccio Federici
- Paediatric Cardiac Surgery and GUCH Unit, Heart Hospital, Monasterio Foundation, Massa, Italy
| | - Pierluigi Festa
- Paediatric Cardiology and GUCH Unit, Heart Hospital, Monasterio Foundation, Massa, Italy
| | - Valeria Piagneri
- Diagnostic Imaging Unit, Heart Hospital, Monasterio Foundation, Massa, Italy
| | - Federico Landra
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Gianfranco Montesi
- Cardiac Surgery Unit, Department of Thoracic and Cardiovascular Disease, Santa Maria alle Scotte Hospital, Siena, Italy
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3
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Shah AH, Oechslin E, Benson L, Crean AM, Silversides C, Bach Y, Wald RM, Roche SL, Osten M, Bruaene AVD, Colman J, Goraya B, Abrahamyan L, Hanneman K, Nguyen E, Horlick E. Long-Term Outcomes of Unrepaired Isolated Partial Anomalous Pulmonary Venous Connection With an Intact Atrial Septum. Am J Cardiol 2023; 201:232-238. [PMID: 37392606 DOI: 10.1016/j.amjcard.2023.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 07/03/2023]
Abstract
The natural history of an unrepaired isolated partial anomalous pulmonary venous connection(s) (PAPVC) and the absence of other congenital anomalies remains unclear. This study aimed to expand the understanding of the clinical outcomes in this population. Isolated PAPVC with an intact atrial septum is a relatively uncommon condition. There is the perception that patients with isolated PAPVC are usually asymptomatic, that the lesion generally has a limited hemodynamic impact, and that surgical repair is rarely justified. For this retrospective study, we reviewed our institutional database to identify patients with either 1 or 2 anomalous pulmonary veins that drain a portion of but not the complete ipsilateral lung. Patients with previous surgical cardiac repair, coexistence of other congenital cardiac anomalies that would result in either pretricuspid or post-tricuspid loading of the right ventricle (RV), or scimitar syndrome were excluded. We reviewed their clinical course over the follow-up period. We identified 53 patients; 41 with a single and 12 with 2 anomalous PAPVC. A total of 30 patients (57%) were men, with a mean age at the latest clinic visit of 47 ± 19 years (18 to 84 years). Turner syndrome (6 of 53, 11.3%), bicuspid aortic valve (6 of 53, 11.3%), and coarctation of the aorta (5 of 53, 9.4%) were commonly associated anomalies. A single anomalous left upper lobe vein was the most commonly identified variation. More than half of the patients were asymptomatic. Cardiopulmonary exercise test demonstrated a maximal oxygen consumption of 73 ± 20% expected (36 to 120). Transthoracic echocardiography demonstrated a mean RV basal diameter of 4.4 ± 0.8 cm, RV systolic pressure of 38 ± 13 (16 to 84) mm Hg. A total of 8 patients (14.8%) had ≥moderate tricuspid regurgitation. Cardiac magnetic resonance in 42 patients demonstrated a mean RV end-diastolic volume index of 122 ±3 0 ml/m2 (66 to 188 ml/m2), of which in 8 (14.8%), it was >150 ml/m2. Magnetic resonance imaging-based Qp:Qs was 1.6 ± 0.3. A total of 5 patients (9.3%) had established pulmonary hypertension (mean pulmonary artery pressure ≥25 mm Hg). In conclusion, isolated single or dual anomalous pulmonary venous connection is not necessarily a benign congenital anomaly because a proportion of patients develop pulmonary hypertension and/or RV dilation. Regular follow-up and on-going patient surveillance with cardiac imaging is advised.
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Affiliation(s)
- Ashish H Shah
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network; St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Erwin Oechslin
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Lee Benson
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network; The Labatt family Heart Center, The Hospital for Sick Children, Division of Cardiology, The University of Toronto School of Medicine
| | - Andrew M Crean
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Candice Silversides
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Yvonne Bach
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Rachel M Wald
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network; The Labatt family Heart Center, The Hospital for Sick Children, Division of Cardiology, The University of Toronto School of Medicine
| | - S Lucy Roche
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network; The Labatt family Heart Center, The Hospital for Sick Children, Division of Cardiology, The University of Toronto School of Medicine
| | - Mark Osten
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Alexander Van De Bruaene
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network; Adult Congenital Heart Disease, University Hospitals Leuven, Leuven, Belgium
| | - Jack Colman
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Burhan Goraya
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Lusine Abrahamyan
- Toronto General Hospital Research Institute, University Health Network; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kate Hanneman
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Elsie Nguyen
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network
| | - Eric Horlick
- Peter Munk Cardiac Center and Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, University Health Network.
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Molina-Lopez VH, Arraut-Hernandez C, Nieves-La Cruz C, Almodovar-Adorno AA, Rivera-Babilonia J. Uncovering an Easily Overlooked Cause of Dyspnea: Partial Anomalous Pulmonary Venous Connection of the Right Pulmonary Vein to the Superior Vena Cava Leading to Right Heart Enlargement. Cureus 2023; 15:e35369. [PMID: 36974235 PMCID: PMC10039799 DOI: 10.7759/cureus.35369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 02/25/2023] Open
Abstract
This case report describes a rare variant of partial anomalous pulmonary venous connections (PAPVCs) in a patient who presented with an insidious progression of dyspnea on exertion as an adult, leading to the diagnosis of PAPVC. The patient had an anomalous right upper pulmonary vein connecting to an anomalous pulmonary-azygos trunk that connected to the cranial superior vena cava (SVC), producing a large left-to-right extracardiac shunt. The diagnosis of PAPVC was made after evaluating for causes of right heart chamber enlargement. This case highlights the importance of considering PAPVC as a potential cause of unclear etiology for exertional dyspnea, right-sided chamber enlargements, and intact atrial septum. The onset and severity of symptoms in patients with PAPVC depend on various factors, including the number of pulmonary veins, site of connection, pulmonary vascular resistance, atrial compliance, and the presence of other congenital heart defects. Therefore, clinicians should maintain a high level of suspicion for PAPVC in patients with these types of symptoms.
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5
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Yonehara K, Terada K, Morine M. Partial anomalous pulmonary venous connection diagnosed prenatally. Pediatr Int 2023; 65:e15507. [PMID: 36794447 DOI: 10.1111/ped.15507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/09/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Kosuke Yonehara
- Department of Pediatric, Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | - Kazuya Terada
- Department of Pediatric Cardiology, Shikoku Medical Center for Children and Adults, Zentsuji, Japan
| | - Mikio Morine
- Department of Obstetrics, Shikoku Medical Center for Children and Adults, Zentsuji, Japan
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Romfh A, Lui GK. PAPVR – An incidental finding that may not be so benign. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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Surgical Outcomes of Three Repair Techniques for Partial Anomalous Pulmonary Venous Connection in Adult Patients. HEARTS 2022. [DOI: 10.3390/hearts3040016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: To investigate primary and secondary surgical outcomes following transcaval repair (TCR), modified Warden repair, and transatrial repair techniques for partial anomalous pulmonary venous connections (PAPVCs) and sinus venosus atrial septal defects (ASDs). Methods: This is an observational cohort clinical study. Patients who underwent TCR, modified Warden repair, and transatrial surgical repair for PAPVC and ASD between January 2003 and October 2019 at our institution were included in the study. Patients had one of the surgical procedures based on the anatomy of the defect. Results: Ten patients, seven (70%) males and three (30%) females, were included in the analysis. Seven patients underwent TCR, two patients the modified Warden technique, and one patient underwent transatrial surgical repair. Mean age was 57 years ± 14.7. Mean EuroScore II was 3.4 ± 3.5. The baseline left ventricle ejection fraction was 45 ± 6.5%. No patient had previous stroke, pacemaker (PM) implantation, or myocardial infarction. Total cardiopulmonary bypass and cross-clamping time were 123 ± 72.5 and 100 ± 48.5 min, respectively. Mean mechanical ventilation, mean intensive care unit, and mean hospital length of stay for the transcaval, modified Warden, and transatrial groups were 4.6 ± 10.7, 5.7 ± 8.8, and 10.5 ± 9.2 days, respectively. Superior caval or pulmonary venous obstruction, sinus node dysfunction, and PM implantation were not present at follow-up. The patient who underwent transatrial repair had died at 5.5-year follow-up due to myocardial infarction. Total survival rate at 6 years was 90%. Conclusions: The findings from this study elicit that all three techniques have low postoperative morbidity and are feasible and reliable procedures.
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Partial anomalous pulmonary venous return in adults: Insight into pulmonary hypertension. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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9
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Managing uncertainty in decision-making of common congenital cardiac defects. Cardiol Young 2022; 32:1705-1717. [PMID: 36300500 DOI: 10.1017/s1047951122003316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Decision-making in congenital cardiac care, although sometimes appearing simple, may prove challenging due to lack of data, uncertainty about outcomes, underlying heuristics, and potential biases in how we reach decisions. We report on the decision-making complexities and uncertainty in management of five commonly encountered congenital cardiac problems: indications for and timing of treatment of subaortic stenosis, closure or observation of small ventricular septal defects, management of new-onset aortic regurgitation in ventricular septal defect, management of anomalous aortic origin of a coronary artery in an asymptomatic patient, and indications for operating on a single anomalously draining pulmonary vein. The strategy underpinning each lesion and the indications for and against intervention are outlined. Areas of uncertainty are clearly delineated. Even in the presence of "simple" congenital cardiac lesions, uncertainty exists in decision-making. Awareness and acceptance of uncertainty is first required to facilitate efforts at mitigation. Strategies to circumvent uncertainty in these scenarios include greater availability of evidence-based medicine, larger datasets, standardised clinical assessment and management protocols, and potentially the incorporation of artificial intelligence into the decision-making process.
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Graham G, Dearani JA, Mathew J, Miranda WR, King KS, Schaff HV, Stephens EH. Partial Anomalous Pulmonary Venous Connection with Intact Atrial Septum: Early and Mid-Term Outcomes. Ann Thorac Surg 2022; 115:1479-1484. [PMID: 35504361 DOI: 10.1016/j.athoracsur.2022.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/21/2022] [Accepted: 04/13/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Partial anomalous pulmonary venous return (PAPVR) with intact atrial septum warrants greater understanding and evaluation in the literature. METHODS From January 1993 to December 2018, 293 patients with PAPVR underwent surgical repair. Of these, 45 patients (15.3%) had an intact atrial septum. The median (1st quartile, 3rd quartile) age was 36 (24-48) years. Direct reimplantation, intra cardiac baffling, and caval division (Warden) technique was used in 17 (38%), 15 (33%), and 13 (29%) patients, respectively. Descriptive statistics were used to assess the data and Kaplan Meier analysis was used to assess survival. RESULTS Anomalous veins were right-sided in 27 patients (60%), left-sided in 16 patients (36%) and bilateral in 2 patients (4%). The insertion sites were the superior vena cava (SVC) 23 (51%), innominate vein 12 (27%), inferior vena cava (IVC) 6 (13%), coronary sinus 2 (4%), right atrium 1 (2%) and unknown in 1 (2%). Scimitar syndrome was noted in 8 patients (18%). There was no postoperative mortality or residual defects. Post-operative echocardiography excluded any obstruction of pulmonary or systemic veins. Post-operative complications included atrial fibrillation in 9 patients (20%) and pneumothorax requiring chest tube in 5 patients (11%). Survival at 1, 5, and 10 years was 100%, 95%, and 95%. Two patients underwent pulmonary vein dilatation one at 3 years the other at 7 years. CONCLUSIONS Surgical repair of PAPVC with intact atrial septum can be performed with excellent early and mid-term outcomes. The overall incidence of mid-term systemic or pulmonary vein stenosis is low.
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Affiliation(s)
- Gabriel Graham
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | - Jessey Mathew
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Katherine S King
- Division of Clinical Trials and Biostatistics, Mayo Clinic, Rochester, MN
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Pinto Pereira J, Ghaye B, Laterre PF, Hantson P. Platypnea-orthodeoxia syndrome in a postoperative patient: a case report. J Med Case Rep 2021; 15:600. [PMID: 34922594 PMCID: PMC8684675 DOI: 10.1186/s13256-021-03185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
Background We report a case of platypnea–orthodeoxia syndrome observed in a complex clinical situation associating a bilateral pleural effusion, lobar pulmonary embolism, and a partial anomalous pulmonary venous return. Case presentation A 57-year-old Caucasian woman developed acute dyspnea in the postoperative course of an elective gynecological surgery for advanced stage ovarian cancer. Preoperative evaluation had failed to reveal any respiratory or cardiac problem. After evidence of a low arterial oxygen saturation, blood gas analysis from the central venous line correctly inserted in the right internal jugular vein revealed a higher oxygen saturation than in the arterial compartment. A thoracic computed tomography showed bilateral pleural effusion, lobar pulmonary embolism, and a drainage of a left pulmonary vein into the left innominate vein. This unique combination resulted in an uncommon cause of platypnea–orthodeoxia syndrome. Conclusion Often associated with right-to-left shunting, platypnea–orthodeoxia syndrome may be observed in complex clinical conditions with several factors influencing the ventilation/perfusion ratio. The paradoxical finding of a higher oxygen saturation in a central venous line than in an arterial line should prompt the clinician to look at the possibility of partial anomalous pulmonary venous return. No specific treatment is required in asymptomatic adults, except for an echocardiographic follow-up to detect the onset of pulmonary hypertension.
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Affiliation(s)
- João Pinto Pereira
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Benoit Ghaye
- Department of Radiology, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Pierre-François Laterre
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, 1200, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques St-Luc, Université catholique de Louvain, Avenue Hippocrate, 10, 1200, Brussels, Belgium.
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Dallapellegrina L, Sciatti E, Vizzardi E, Metra M. Heart failure and pulmonary hypertension in a patient with partial anomalous pulmonary venous return and hyperthyroidism: a case report. J Cardiovasc Med (Hagerstown) 2021; 22:e15-e17. [PMID: 34747929 DOI: 10.2459/jcm.0000000000001205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Lucia Dallapellegrina
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
| | - Edoardo Sciatti
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
| | - Enrico Vizzardi
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.,Cardio-Thoracic Department, ASST Spedali Civili, Brescia, Italy
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13
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Hatipoglu S, Almogheer B, Mahon C, Houshmand G, Uygur B, Giblin GT, Krupickova S, Baksi AJ, Alpendurada F, Prasad SK, Babu-Narayan SV, Gatzoulis MA, Mohiaddin RH, Pennell DJ, Izgi C. Clinical Significance of Partial Anomalous Pulmonary Venous Connections (Isolated and Atrial Septal Defect Associated) Determined by Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2021; 14:e012371. [PMID: 34384233 DOI: 10.1161/circimaging.120.012371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance. METHODS We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases. RESULTS A total of 215 patients (median age 46 years; range, 6-83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively; P=0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57-157] mL/m2, P=0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure. CONCLUSIONS This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction.
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Affiliation(s)
- Suzan Hatipoglu
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Batool Almogheer
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Ciara Mahon
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Golnaz Houshmand
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- Royal Brompton Hospital, London, United Kingdom; Now with Rajaie Cardiovascular Medical and Research Centre, Tehran, Iran (G.H.)
| | - Begum Uygur
- Cardiology Department, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Turkey (B.U.)
| | - Gerard T Giblin
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
| | - Sylvia Krupickova
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom (S.K.)
| | - A John Baksi
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Francisco Alpendurada
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
| | - Sanjay K Prasad
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
| | - Sonya V Babu-Narayan
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Michael A Gatzoulis
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Raad H Mohiaddin
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Dudley J Pennell
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
- National Heart & Lung Institute, Imperial College, London, United Kingdom (S.K., A.J.B., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P.)
| | - Cemil Izgi
- Cardiology Department & Cardiovascular Research Centre (S.H., B.A., C.M., G.T.G., A.J.B., F.A., S.K.P., S.V.B.-N., M.A.G., R.H.M., D.J.P., C.I.)
- Cardiovascular Magnetic Resonance Unit (S.H., B.A., C.M., G.H., G.T.G., S.K., S.V.B.-N., R.H.M., D.J.P., C.I.)
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14
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Zor AK, Beşikçi R, Aydıner Ö. A modified suprasternal approach in transthoracic echocardiography for isolated left upper partial anomalous pulmonary venous connection: Hard to diagnose, easy to miss. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:597-601. [PMID: 33644876 DOI: 10.1002/jcu.22997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Isolated left upper partial anomalous pulmonary venous connection (PAPVC) via the innominate vein to the right atrium is a rare congenital anomaly. This study was undertaken to determine the efficacy of a modified suprasternal view in transthoracic echocardiography (TTE) for the detection of left upper PAPVC. METHODS After the incidental diagnosis of left upper PAPVC in our first patient in 2008, we added a modified suprasternal view to all TTEs performed in our pediatric cardiology clinic. This was obtained by tilting the tail of the probe 30-450 towards the right shoulder of the patient during suprasternal long axis view for a better visualization of the innominate vein. RESULTS Among 7200 patients who underwent TTEs between 2008 and 2020, we identified 13 patients with left upper PAPVC into the innominate vein. All were asymptomatic children with normal cardiac chambers and no accompanying congenital disorders. In 10 cases, diagnoses were confirmed by multi-slice computerized tomography, whereas one patient underwent catheterization for confirmation. CONCLUSION Isolated left upper PAPVC to the innominate vein is a rare congenital disorder that can be present in asymptomatic children with normal cardiac chambers. TTE, with a modified approach in suprasternal long axis view, has a high diagnostic value in the detection of this condition.
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Affiliation(s)
| | - Resmiye Beşikçi
- Department of Pediatric Cardiology, Anadolu Medical Center, Gebze, Turkey
| | - Ömer Aydıner
- Department of Radiology, Ministry of Health, İstanbul Provincial Health Directorate, Dr Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
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15
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Identifying partial anomalous pulmonary venous connection in the superior vena cava before pulmonary resection. Gen Thorac Cardiovasc Surg 2021; 69:1313-1319. [PMID: 33900520 DOI: 10.1007/s11748-021-01639-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE There are only limited reports on pulmonary resection complicated with partial anomalous pulmonary venous connection. Preoperative partial anomalous pulmonary venous connection was overlooked in approximately 50% of these reports, while most cases of were located on the same side as the pulmonary resection. We examined the prevalence of overlooked partial anomalous pulmonary venous connection and determined appropriate measures to avoid misdiagnosis. METHODS We retrospectively reviewed the records and computed tomography data of consecutive patients who underwent pulmonary resection at the University of Yamanashi Hospital between 2006 and 2019. We re-evaluated the computed tomography images in horizontal and coronal views, focusing on the four common sites of partial anomalous pulmonary venous connection. Further, we conducted a literature review of studies that reported partial anomalous pulmonary venous connection cases. RESULTS Among the 1389 patients who underwent pulmonary resection, 1205 were enrolled. There were five partial anomalous pulmonary venous connection cases (0.41%). Two were diagnosed through re-evaluation. The partial anomalous pulmonary venous connection was located between the right upper lobe and the superior vena cava in four patients (80%). All patients underwent left superior segmentectomy, and none experienced postoperative heart failure or hypoxia. In the literature, the incidence rates of partial anomalous pulmonary venous connection observed by computed tomography (0.1-0.25%) were lower than those observed by autopsy (0.62%) and angiography (0.82%). CONCLUSION There may be a considerable number of overlooked partial anomalous pulmonary venous connection cases. Therefore, particularly the superior vena cava should be carefully monitored in preoperative computed tomography examinations.
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16
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Smart R, Gegova J, Wade A, Thrower A. Central venous catheter misplacement into an aberrant pulmonary vein: implications of a congenital variation. Br J Anaesth 2021; 126:e208-e210. [PMID: 33836854 DOI: 10.1016/j.bja.2021.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 02/08/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Rebecca Smart
- Department of Anaesthetics, Basingstoke and North Hampshire Hospital, Basingstoke, UK.
| | - Julieta Gegova
- Department of Anaesthetics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Andrew Wade
- Department of Anaesthetics, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Andrew Thrower
- Department of Radiology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
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17
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A Salas de Armas I, Patel MK, Akkanti B, Salazar J, Kar B, Gregoric ID. Partial anomalous pulmonary venous return after orthotopic heart transplantation case report. BMC Cardiovasc Disord 2021; 21:8. [PMID: 33407125 PMCID: PMC7789624 DOI: 10.1186/s12872-020-01818-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 12/09/2020] [Indexed: 11/25/2022] Open
Abstract
Background Partial anomalous pulmonary venous return (PAPVR) is a congenital heart defect. Reports of repair and treatment in pediatric cases have been published, but incidence of PAPVR in adults is not common. To our knowledge, there has not been a diagnosis of left-sided PAPVR after a heart transplant an in adult patient. Case presentation A 62-year-old patient with ischemic cardiomyopathy and systolic heart failure underwent orthotopic heart transplantation. The immediate post-operative course was remarkable for an elevated cardiac index and pulmonary artery pressures as well as decreased systemic vascular resistance. The post-operative echocardiogram did not reveal an intra-cardiac shunt. However, computed tomographic angiography (CTA) showed a left superior pulmonary vein draining into the innominate vein. Operative repair of the left superior pulmonary venous connection to the left atrial appendage was completed under cardiopulmonary bypass with beating heart. Her hemodynamics improved immediately, and she had an unremarkable postoperative course. Conclusions While uncommon, any patient with a high cardiac output and abnormal hemodynamics after heart transplant should be evaluated for the existence of a shunt. While not a part of all traditional preoperative imaging protocols, a chest CTA should be considered if PAPVR is suspected as it can both diagnose the condition and enable a plot of the corrective course of surgical action.
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Affiliation(s)
- Ismael A Salas de Armas
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin St., Suite 2350, Houston, TX, 77030, USA
| | - Manish K Patel
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin St., Suite 2350, Houston, TX, 77030, USA
| | - Bindu Akkanti
- Department of Internal Medicine, Divisions of Critical Care, Pulmonary and Sleep, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Jorge Salazar
- Pediatric Cardiothoracic Surgery, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, Houston, TX, USA
| | - Biswajit Kar
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin St., Suite 2350, Houston, TX, 77030, USA
| | - Igor D Gregoric
- Department of Advanced Cardiopulmonary Therapies and Transplantation, Center for Advanced Heart Failure, The University of Texas Health Science Center at Houston/Memorial Hermann Hospital - Texas Medical Center, 6400 Fannin St., Suite 2350, Houston, TX, 77030, USA.
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18
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Morishita A, Hagino I, Tomioka H, Katahira S, Hoshino T, Hanzawa K. Novel technique of repairing right partial anomalous pulmonary venous connection with intact atrial septum using in situ interatrial septum as a flap in a 68-year-old-woman: a case report. J Cardiothorac Surg 2020; 15:269. [PMID: 32977845 PMCID: PMC7519534 DOI: 10.1186/s13019-020-01313-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partial anomalous pulmonary venous connection draining into the right atrium with an intact atrial septum is a very rare clinical entity in the adult population. Partial anomalous pulmonary venous connection must be suspected as a differential diagnosis when the cause of right heart enlargement and pulmonary artery hypertension is unknown. CASE PRESENTATION This study describes the surgical case of an isolated right partial anomalous pulmonary venous connection to the right atrium in a 68-year-old woman, who underwent tricuspid ring annuloplasty and right-sided maze procedure simultaneously. She had complaints of gradually progressing dyspnea on exertion. However, a diagnosis could not be established despite consultations at multiple hospitals for over a year. Right heart catheterization revealed severe pulmonary artery hypertension with a mean pulmonary artery pressure of 46 mmHg, step-up phenomenon of oxygen saturation at the mid-level of the right atrium with a pulmonary-to-systemic blood flow ratio of 2.4, and a pulmonary vascular resistance of 3.1 Wood Units. As medical treatment with pulmonary artery vasodilator therapy did not improve her symptoms, she underwent surgical repair. An atrial septal defect was created surgically with a curvilinear tongue-shaped cut. The right anomalous pulmonary veins were rerouted through the surgically created atrial septal defect into the left atrium with a baffle comprised of the interatrial septum flap, kept in continuity with the anterior margin and sutured while mobilizing the enlarged right atrium. The patient had an uneventful postoperative course and remains asymptomatic. CONCLUSIONS The described surgical technique could be considered an effective alternative for patients undergoing surgical repair for a partial anomalous pulmonary venous connection isolated to the right atrium. The indication for surgery must be judged on a case-by-case basis in these patients with prevalent systemic-to-pulmonary shunting.
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Affiliation(s)
- Atsushi Morishita
- Department of Cardiovascular Surgery, Numata Neurosurgery Heart-Disease Hospital, 8 Sakae-cho, Numata, 378-0014, Japan.
| | - Ikuo Hagino
- Department of Cardiovascular Surgery, Chiba Children's Hospital, Chiba, Japan
| | - Hideyuki Tomioka
- Department of Cardiovascular Surgery, Tokyo Women's Medical University Yachio Medical Center, Yachio, Japan
| | - Seiichiro Katahira
- Division of Health Administration, Hamakawasaki Operation Center, Toshiba Human Asset Service Corporation, Kawasaki, Japan
| | - Takeshi Hoshino
- Department of Anesthesiology, Minami Machida Hospital, Machida, Japan
| | - Kazuhiko Hanzawa
- Department of Advanced Treatment and Prevention for Vascular Disease and Embolism, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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19
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Verma A, Jacobson X, Nordick K, Nicchi V, Balters M. Partial anomalous pulmonary venous return in a patient undergoing left upper lobectomy for adenocarcinoma of the lung: A case report. Int J Surg Case Rep 2020; 76:90-93. [PMID: 33017741 PMCID: PMC7533348 DOI: 10.1016/j.ijscr.2020.09.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 12/05/2022] Open
Abstract
Surgical management of left superior pulmonary venous return directly to the left innominate/brachiocephalic vein in patient with pulmonary adenocarcinoma. Left upper lobectomy in patient with adenocarcinoma of the lung in the presence of partial anomalous pulmonary venous return. Case report describing operative management of adenocarcinoma of the lung in a patient afflicted with partial anomalous pulmonary venous return of left superior pulmonary vein into the left brachiocephalic vein.
Introduction Partial anomalous pulmonary venous return (PAPVR) is a rare congenital heart disease that complicates surgical management of pulmonary pathology. Case presentation This case describes the successful management of a 73-year-old female with a left upper lobe adenocarcinoma and pre-operative discovery of left superior anomalous pulmonary venous return into the innominate vein. This patient presented to our clinic for evaluation regarding her newly discovered adenocarcinoma of the lung. Here, we also discuss findings in the literature for management of these patients regarding the importance of preoperative evaluation to determine the extent to which a lobectomy will alter pulmonary function with special emphasis on identifying patients at risk of increased shunting leading to cardiopulmonary failure. Conclusion Consideration should focus on the extent of the shunting, the presence of symptoms, and underlying right heart strain or pulmonary hypertension.
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Affiliation(s)
- Ankit Verma
- Creighton University, Department of Surgery, 7710 Mercy Rd., Suite 501, Omaha, NE, 68124, United States
| | - Xander Jacobson
- Creighton University, Department of Surgery, 7710 Mercy Rd., Suite 501, Omaha, NE, 68124, United States
| | - Katherine Nordick
- Creighton University, Department of Surgery, 7710 Mercy Rd., Suite 501, Omaha, NE, 68124, United States
| | - Vincent Nicchi
- Creighton University, Department of Surgery, 7710 Mercy Rd., Suite 501, Omaha, NE, 68124, United States
| | - Marcus Balters
- Creighton University, Department of Surgery, 7710 Mercy Rd., Suite 501, Omaha, NE, 68124, United States.
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20
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Sadeghi AH, Van de Woestijne P, Taverne YJ, Van Dijk APJ, Bogers AJJC. An unusual case of redo tricuspid valve replacement and repair of a previously unidentified anomalous pulmonary venous return in a patient with congenitally corrected transposition of the great arteries. Clin Case Rep 2020; 8:1241-1246. [PMID: 32695367 PMCID: PMC7364110 DOI: 10.1002/ccr3.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 11/23/2022] Open
Abstract
Associated cardiovascular malformations in congenitally corrected transposition of the great arteries (CCTGA) should not be missed when a patient requires surgical correction. We present a case of an adult CCTGA patient who required redo surgery for recurrent tricuspid (left atrioventricular) valve regurgitation and previously unidentified partial anomalous pulmonary venous return.
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Affiliation(s)
- Amir H. Sadeghi
- Department of Cardiothoracic SurgeryAcademic Center for Congenital Heart DiseaseErasmus University Medical CenterRotterdamThe Netherlands
| | - Pieter Van de Woestijne
- Department of Cardiothoracic SurgeryAcademic Center for Congenital Heart DiseaseErasmus University Medical CenterRotterdamThe Netherlands
| | - Yannick J.H.J. Taverne
- Department of Cardiothoracic SurgeryAcademic Center for Congenital Heart DiseaseErasmus University Medical CenterRotterdamThe Netherlands
| | - Arie P. J. Van Dijk
- Department of CardiologyAcademic Center for Congenital Heart DiseaseRadboud University Medical CenterNijmegenThe Netherlands
| | - Ad J. J. C. Bogers
- Department of Cardiothoracic SurgeryAcademic Center for Congenital Heart DiseaseErasmus University Medical CenterRotterdamThe Netherlands
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21
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Abstract
Approximately 50 million adults worldwide have known congenital heart disease (CHD). Among the most common types of CHD defects in adults are atrial septal defects and ventricular septal defects followed by complex congenital heart lesions such as tetralogy of Fallot. Adults with CHDs are more likely to have hypertension, cerebral vascular disease, diabetes and chronic kidney disease than age-matched controls without CHD. Moreover, by the age of 50, adults with CHD are at a greater than 10% risk of experiencing cardiac dysrhythmias and approximately 4% experience sudden death. Consequently, adults with CHD require healthcare that is two- to four-times greater than adults without CHD. This paper discusses the diagnosis and treatment of adults with atrial septal defects, ventricular septal defects and tetralogy of Fallot.
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Affiliation(s)
- Robert J Henning
- School of Public Health, University of South Florida, Tampa, FL 33612, USA
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22
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Lewis RA, Billings CG, Bolger A, Bowater S, Charalampopoulos A, Clift P, Elliot CA, English K, Hamilton N, Hill C, Hurdman J, Jenkins PJ, Johns C, MacDonald S, Oliver J, Papaioannou V, Rajaram S, Sabroe I, Swift AJ, Thompson AAR, Kiely DG, Condliffe R. Partial anomalous pulmonary venous drainage in patients presenting with suspected pulmonary hypertension: A series of 90 patients from the ASPIRE registry. Respirology 2020; 25:1066-1072. [PMID: 32249494 PMCID: PMC8653892 DOI: 10.1111/resp.13815] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 11/30/2022]
Abstract
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 DLCO (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. See relatedEditorial
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Affiliation(s)
- Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Catherine G Billings
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Aidan Bolger
- Department of Adult Congenital Cardiology, Glenfield Hospital, Leicester, UK
| | - Sarah Bowater
- Department of Adult Congenital Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Paul Clift
- Department of Adult Congenital Cardiology, Queen Elizabeth Hospital, Birmingham, UK
| | - Charlie A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Kate English
- Department of Adult Congenital Cardiology, Leeds General Infirmary, Leeds, UK
| | - Neil Hamilton
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Catherine Hill
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Judith Hurdman
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Petra J Jenkins
- Department of Adult Congenital Cardiology, Manchester Royal Infirmary, Manchester, UK
| | - Christopher Johns
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Simon MacDonald
- Department of Adult Congenital Cardiology, Glenfield Hospital, Leicester, UK
| | - James Oliver
- Department of Adult Congenital Cardiology, Leeds General Infirmary, Leeds, UK
| | - Vasilios Papaioannou
- Department of Adult Congenital Cardiology, Manchester Royal Infirmary, Manchester, UK
| | - Smitha Rajaram
- Department of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Ian Sabroe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Andy J Swift
- Department of Academic Radiology, University of Sheffield, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - A A Roger Thompson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK.,Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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23
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e637-e697. [PMID: 30586768 DOI: 10.1161/cir.0000000000000602] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative. §§Former Task Force member; current member during the writing effort
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2020; 139:e698-e800. [PMID: 30586767 DOI: 10.1161/cir.0000000000000603] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Karen K Stout
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Curt J Daniels
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jamil A Aboulhosn
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Biykem Bozkurt
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Craig S Broberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Jack M Colman
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephen R Crumb
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Joseph A Dearani
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Stephanie Fuller
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michelle Gurvitz
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Paul Khairy
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Michael J Landzberg
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Arwa Saidi
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - Anne Marie Valente
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
| | - George F Van Hare
- Writing committee members are required to recuse themselves from voting on sections to which their specific relationships with industry may apply; see Appendix 1 for recusal information. †ACC/AHA Representative. ‡International Society for Adult Congenital Heart Disease Representative. §Society for Cardiovascular Angiography and Interventions Representative. ‖ACC/AHA Task Force on Clinical Practice Guidelines Liaison. ¶Society of Thoracic Surgeons Representative. #American Association for Thoracic Surgery Representative. **ACC/AHA Task Force on Performance Measures Liaison. ††American Society of Echocardiography Representative. ‡‡Heart Rhythm Society Representative
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Hegde M, Manjunath SC, Usha MK. Isolated Partial Anomalous Pulmonary Venous Connection: Development of Volume Overload and Elevated Estimated Pulmonary Pressure in Adults. J Clin Imaging Sci 2019; 9:29. [PMID: 31508264 PMCID: PMC6712552 DOI: 10.25259/jcis-8-2019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/18/2019] [Indexed: 11/21/2022] Open
Abstract
Objective: Partial anomalous pulmonary venous connection (PAPVC) is one of the rare congenital cardiac diseases with a prevalence of 0.4–0.7% of autopsies. The prevalence of a partial anomalous pulmonary venous connection is 0.2% in computed tomography (CT) among adults. We chose to study the association between isolated PAPVC and volume overload, estimated systolic pulmonary artery pressure in a tertiary care center for cardiovascular diseases. Methods: CT report database was searched for keywords of partial anomalous pulmonary venous connection, pulmonary hypertension, dilated right atrium (RA), and right ventricle (RV). Both pediatric and adult population were considered. All the dedicated studies of non-coronary cardiac evaluation, pulmonary arteries, and thorax were included in the study. Echocardiography was performed in all the subjects. In adults, abnormalities searched were features of volume overload of RA and RV and estimated systolic pulmonary pressure of 45 mmHg. Biphasic studies were performed, and upper abdomen was included in the CT studies. Results: Among the 110 subjects, 54 (49%) had isolated PAPVC. Of 54, 26 patients had volume overload of RA/RV or elevated estimated systolic pulmonary artery pressure. There is a significant association between drainage of anomalous veins to superior vena cava (SVC) and age >18 years (Chi-squared test P = 0.003). Among patients with isolated PAPVC, 18 had anomalous drainage to the SVC. Among isolated PAPVC cases, 38 were of the age >18 years. We found statistically significant association (P = 0.02) between isolated PAPVC in adults and pulmonary hypertension. Conclusion: Isolated PAPVC has association with the development of pulmonary hypertension in adults, approaching statistically significant p value. Because isolated PAPVC is a clinically significant independent risk factor, it should be actively treated to prevent the development of pulmonary hypertension later in life, which may result in severe clinical consequences.
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Affiliation(s)
- Madhav Hegde
- Department of Radiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India
| | - Satvik Cholenahalli Manjunath
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - M K Usha
- Department of Pediatric Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Cherian SV, Kumar A, Ocazionez D, Estrada -Y- Martin RM, Restrepo CS. Developmental lung anomalies in adults: A pictorial review. Respir Med 2019; 155:86-96. [PMID: 31326738 DOI: 10.1016/j.rmed.2019.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 06/03/2019] [Accepted: 07/05/2019] [Indexed: 11/16/2022]
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Abstract
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.
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Affiliation(s)
| | - Peng Teng
- Department of Cardiothoracic Surgery
| | - Yanyan Yang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Zhejiang Province, P.R. China
| | - Yiming Ni
- Department of Cardiothoracic Surgery
| | - Liang Ma
- Department of Cardiothoracic Surgery
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Warden Procedure in a 77-Year-Old Man. Ann Thorac Surg 2019; 108:e319-e321. [PMID: 30922823 DOI: 10.1016/j.athoracsur.2019.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 02/09/2019] [Accepted: 02/17/2019] [Indexed: 11/20/2022]
Abstract
Partial anomalous pulmonary venous return is a rare congenital heart defect characterized by 1 or more but not all of the pulmonary veins draining somewhere other than the left atrium, thereby creating a left-to-right shunt. Over time, right-sided volume overload may develop with its subsequent complications. We present a case of isolated partial anomalous pulmonary venous return in an older patient who underwent a Warden procedure at age 77 years, with rapid improvement in right ventricular size and function.
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Ishida N, Shimabukuro K, Yamaguchi S, Umeda E, Ogura H, Mitta S, Kimata R, Takemura H, Doi K. Surgical repair of partial anomalous pulmonary venous return with intact atrial septum in a 65-year-old woman: a case report. J Med Case Rep 2018; 12:350. [PMID: 30470244 PMCID: PMC6260651 DOI: 10.1186/s13256-018-1874-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Partial anomalous pulmonary venous return is a rare congenital cardiac anomaly that usually involves the right pulmonary vein and an atrial septal defect. Isolated partial anomalous pulmonary venous return with an intact atrial septum is even rarer, and this condition is usually treated surgically in younger patients. We describe isolated partial anomalous pulmonary venous return in a 65-year-old woman who was treated by caval division with pericardial patch baffling through a surgically created atrial septal defect and reconstruction of the superior vena cava using a prosthetic graft. CASE PRESENTATION A 65-year-old Asian woman who presented with exertional dyspnea was diagnosed with isolated partial anomalous pulmonary venous return. The surgical indications and strategy were controversial because of the rarity of this pathology. She had an indication for surgery because she was symptomatic and had a high ratio of pulmonary to systemic blood flow. We considered that surgical procedures should avoid postoperative stenosis of a reconstructed flow tract, sinus node dysfunction, and thrombogenesis. We created a caval division with pericardial patch baffling through a surgically created atrial septal defect and reconstructed the superior vena cava using a prosthetic graft for the isolated partial anomalous pulmonary venous return. She has since remained free of exertional dyspnea, arrhythmia, and thrombotic complications. This surgical strategy is safe and effective for treating isolated partial anomalous pulmonary venous return in older symptomatic adults. CONCLUSIONS The long-term outcome of surgical repair of partial anomalous pulmonary venous return with an intact atrial septum in our patient, a symptomatic 65-year-old woman, was excellent.
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Affiliation(s)
- Narihiro Ishida
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan.
| | - Katsuya Shimabukuro
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Shojiro Yamaguchi
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Etsuji Umeda
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Hiroki Ogura
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Shohei Mitta
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Ryutaro Kimata
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan
| | - Hirofumi Takemura
- Department of Thoracic, Cardiovascular and General Surgery, Kanazawa University, Kanazawa City, 920-8641, Japan
| | - Kiyoshi Doi
- Department of General and Cardiothoracic Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu City, 501-1194, Japan
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Abstract
We present the case of a critically ill woman whose dialysis line was noted to be circulating bright red blood. Located in the right internal jugular vein, the line had previously been working normally with the change occurring shortly after the patient was liberated from positive pressure mechanical ventilation. An arterial malposition was ruled out and subsequent investigations revealed the presence of a left-sided partial anomalous pulmonary venous connection (PAPVC) that had been previously undiagnosed. The identification of a left-sided PAPVC from blood gas measurements taken from a right internal jugular vein dialysis catheter in this case provides an informative opportunity to consider the intricate physiological relationship between the respiratory and cardiovascular systems in critically ill patients requiring invasive procedures and treatments.
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Affiliation(s)
- Diana Elena Amariei
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert Michael Reed
- Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:e81-e192. [PMID: 30121239 DOI: 10.1016/j.jacc.2018.08.1029] [Citation(s) in RCA: 487] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Tanaka N, Jujo T, Sugiura T, Matsuura K, Kobayashi T, Naito A, Shimazu K, Kasai H, Suda R, Nishimura R, Ikari J, Sakao S, Tanabe N, Matsumiya G, Tatsumi K. Partial anomalous pulmonary venous return with dual drainage to the superior vena cava and left atrium with pulmonary hypertension. Respir Med Case Rep 2018; 25:112-115. [PMID: 30109193 PMCID: PMC6088432 DOI: 10.1016/j.rmcr.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 08/05/2018] [Indexed: 10/29/2022] Open
Abstract
Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiovascular anomaly. A 68-year-old woman was referred to our hospital for detailed examination for pulmonary hypertension (PH). She had been diagnosed as having pulmonary artery dilation and suspected to have PH during a health check seven years prior. A contrast computed tomography showed that the right upper pulmonary vein (RUPV) returned to the superior vena cava (SVC) with a preserved normal connection to the left atrium (LA). Surgical repair was performed. We reported an extremely rare case of isolated PAPVR with PH showing dual drainage into the SVC and LA.
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Affiliation(s)
- Nozomi Tanaka
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Takayuki Jujo
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan.,Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Japan
| | - Toshihiko Sugiura
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Kaoru Matsuura
- Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Takayuki Kobayashi
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Akira Naito
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan.,Department of Advancing Research on Treatment Strategies for Respiratory Disease, Graduate School of Medicine, Chiba University, Japan
| | - Kengo Shimazu
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Hajime Kasai
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Rika Suda
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Rintaro Nishimura
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Jun Ikari
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Seiichiro Sakao
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
| | - Nobuhiro Tanabe
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan.,Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Koichiro Tatsumi
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, Japan
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2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 73:1494-1563. [PMID: 30121240 DOI: 10.1016/j.jacc.2018.08.1028] [Citation(s) in RCA: 320] [Impact Index Per Article: 53.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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da Silveira LMV, Gus M, Torres FS, Fuchs FD, Fuchs SC. Partial anomalous pulmonary venous connection in a 72-year-old woman: A case report. SAGE Open Med Case Rep 2018; 6:2050313X18787646. [PMID: 30046447 PMCID: PMC6055106 DOI: 10.1177/2050313x18787646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 04/10/2018] [Indexed: 11/17/2022] Open
Abstract
Partial Anomalous Pulmonary Venous Connection is a congenital abnormality characterized by drainage of one or more, but not all, pulmonary veins to the right atrium or to one of the systemic veins. This pathology has low prevalence, although it probably is underestimated and is rarely diagnosed in adults. This report describes a case of a 72-year-old woman with long-term worsening shortness of breath and elevated pulmonary artery systolic pressure in which Partial Anomalous Pulmonary Venous Connection was occasionally diagnosed through imaging methods.
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Affiliation(s)
- Lucas Molinari Veloso da Silveira
- Centro de Pesquisa Clínica, Hospital de Clínicas de Porto Alegre, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Miguel Gus
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Felipe Soares Torres
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávio Danni Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.,Division of Cardiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Sandra Costa Fuchs
- Postgraduate Studies Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Goyal R, Gracia E, Fan R. The Role of Superior Vena Cava Isolation in the Management of Atrial Fibrillation. J Innov Card Rhythm Manag 2017; 8:2674-2680. [PMID: 32494445 PMCID: PMC7252918 DOI: 10.19102/icrm.2017.080406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 04/11/2017] [Indexed: 12/25/2022] Open
Abstract
The superior vena cava (SVC) has been identified as one of the most common sources of non-pulmonary vein triggers for atrial fibrillation (AF). SVC isolation has been shown to improve long-term maintenance of normal sinus rhythm in patients with paroxysmal AF. However, ablation at the SVC is associated with risks of phrenic nerve injury, sinus node dysfunction, and SVC stenosis. The use of electroanatomical mapping, intracardiac echocardiography, compound motor action potentials, and segmental (rather than circumferential) ablation are all strategies to reduce complications. Given these risks, SVC isolation is most effective as an adjunct to pulmonary vein isolation for patients with paroxysmal AF who have been found to have an arrhythmogenic SVC.
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Affiliation(s)
- Rajat Goyal
- Department of Cardiology, Stony Brook University Hospital, Stony Brook, NY
| | - Ely Gracia
- Department of Internal Medicine, Stony Brook University Hospital, Stony Brook, NY
| | - Roger Fan
- Heart Rhythm Center, Stony Brook University Hospital, Stony Brook, NY
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An unusual type of partial anomalous pulmonary venous return with all pulmonary veins draining to left atrium (!). Int J Cardiol 2016; 223:173-175. [DOI: 10.1016/j.ijcard.2016.08.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 08/03/2016] [Indexed: 11/23/2022]
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Arterial Pulmonary Hypertension Secondary to Partial Anomalous Pulmonary Venous Return in an Elderly Patient. Arch Bronconeumol 2016; 53:38-39. [PMID: 27660096 DOI: 10.1016/j.arbres.2016.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/23/2022]
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Partial anomalous pulmonary venous return to the azygos vein: A case report. J Formos Med Assoc 2016; 115:481-2. [DOI: 10.1016/j.jfma.2015.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 11/20/2022] Open
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Sormani P, Roghi A, Cereda A, Peritore A, Milazzo A, Quattrocchi G, Giannattasio C, Pedrotti P. Partial Anomalous Pulmonary Venous Return as Rare Cause of Right Ventricular Dilation: A Retrospective Analysis. CONGENIT HEART DIS 2016; 11:365-8. [PMID: 27237845 DOI: 10.1111/chd.12382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Partial anomalous pulmonary venous return (PAPVR) is an uncommon cause of right ventricular dilation. It may be difficult to identify and often remains undiagnosed. METHODS We reviewed the database of the Cardiac Magnetic Resonance (CMR) Laboratory of Niguarda Hospital, in order to identify the cases of PAPVR between 2008 and 2014. RESULTS On a total number of 7832 CMR scans, we identified 24 patients with PAPVR (14 male, age 41 ± 18 y) corresponding to 0.31% of the total population. Only 30% of patients had been referred for known or suspected PAPVR, 33% of patients had been referred for suspected right ventricular arrhythmogenic dysplasia and 37% had been referred for other cardiac disease. PAPVR involved mainly the right pulmonary veins (18 patients, 75%) and in 62% of our cases was associated with an atrial septal defect. Eight patients underwent corrective surgery in our institution, which confirmed and successfully repaired the anomalies. CONCLUSIONS PAPVR is a rare congenital cardiac pathology which should be suspected in case of unexplained right chambers enlargement. CMR imaging allows an accurate anatomic and functional definition of this pathology and associated abnormalities. Early correction has an excellent prognosis and prevents long term complications like pulmonary hypertension, right ventricular failure and atrial fibrillation.
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Affiliation(s)
- Paola Sormani
- Health Science Department, Bicocca University, Milan, Italy
| | - Alberto Roghi
- Cardiovascular Department, Niguarda Ca Granda Hospital, CMR Laboratory, Cardiology 4, Milan, Italy
| | - Alberto Cereda
- Health Science Department, Bicocca University, Milan, Italy
| | | | - Angela Milazzo
- Cardiovascular Department, Niguarda Ca Granda Hospital, CMR Laboratory, Cardiology 4, Milan, Italy
| | - Giuseppina Quattrocchi
- Cardiovascular Department, Niguarda Ca Granda Hospital, CMR Laboratory, Cardiology 4, Milan, Italy
| | - Cristina Giannattasio
- Health Science Department, Bicocca University, Milan, Italy.,Cardiovascular Department, Niguarda Ca Granda Hospital, CMR Laboratory, Cardiology 4, Milan, Italy
| | - Patrizia Pedrotti
- Cardiovascular Department, Niguarda Ca Granda Hospital, CMR Laboratory, Cardiology 4, Milan, Italy
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Nicolson G, Daley M, Makara M, Beijerink N. Partial anomalous pulmonary venous connection with suspected pulmonary hypertension in a cat. J Vet Cardiol 2016; 17 Suppl 1:S354-9. [PMID: 26776593 DOI: 10.1016/j.jvc.2015.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/16/2022]
Abstract
Partial anomalous pulmonary venous connection has previously been reported in the dog, but never in a cat. A 14-month-old Devon Rex cat was presented for echocardiography to evaluate a heart murmur noticed during a routine examination. The pertinent finding was right-sided cardiomegaly in the absence of an atrial septal defect or tricuspid regurgitation; pulmonary hypertension was suspected. A thoracic computed tomographic angiography study identified a partial anomalous pulmonary venous connection with the lobar veins of the left caudal, right middle, right caudal and accessory lung lobes draining into the caudal vena cava. The resultant volume overload is an easily overlooked differential diagnosis for right-sided cardiac enlargement. This is the first such report of this anomaly in a cat.
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Affiliation(s)
- Geoff Nicolson
- Division of Cardiology, Evelyn Williams Building B10, Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - Michael Daley
- Division of Cardiology, Evelyn Williams Building B10, Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - Mariano Makara
- Division of Diagnostic Imaging, Evelyn Williams Building B10, Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia
| | - Niek Beijerink
- Division of Cardiology, Evelyn Williams Building B10, Faculty of Veterinary Science, University of Sydney, NSW 2006, Australia.
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Jujo T, Tanabe N, Sugiura T, Naito A, Shigeta A, Kitazono-Saitoh M, Sakao S, Tatsumi K. Importance of carefully interpreting computed tomography images to detect partial anomalous pulmonary venous return. Respir Investig 2015; 54:69-74. [PMID: 26718147 DOI: 10.1016/j.resinv.2015.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 07/24/2015] [Accepted: 08/25/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND Partial anomalous pulmonary venous return (PAPVR) is characterized by an abnormal connection of the pulmonary vein (PV). The left-to-right shunt results in an increased pulmonary blood flow, which may be followed by developing pulmonary hypertension (PH). We found that computed tomography (CT) scans may be misinterpreted, potentially leaving anomalous PVs undetected when reviewing diagnostic findings of PAPVR patients. The purpose of this study was to delineate this risk and assess the usefulness of our interpretation methods. METHODS We retrospectively reviewed the records of 8 patients diagnosed with PAPVR, diagnosed with right heart catheterization (RHC) findings, at our department between 1991 and 2013. Our CT screening method for assessing anomalous PVs consisted of two points: 1) confirming that four PVs were connected to the left atrium (LA) and 2) checking that the vena cava was not connected with anomalous PVs. The accuracy of this method was analyzed in a blinded manner. RESULTS In 4 patients, anomalous PVs delineated on enhanced CT scan images obtained before RHC were undetected. The sensitivity and specificity of detecting PAPVRs using our protocol were 0.800 and 0.978, respectively. Four of 8 patients went on to develop PH. Age at the time of diagnosis was positively correlated with mean pulmonary arterial pressure (r=0.929, p=0.002). CONCLUSION There is a potential risk of CT scan misinterpretation when looking for anomalous PVs. Careful interpretation of CT findings that focus on PVs may be useful for detecting PAPVR and obtaining a PH differential diagnosis.
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Affiliation(s)
- Takayuki Jujo
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
| | - Nobuhiro Tanabe
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
| | - Toshihiko Sugiura
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
| | - Akira Naito
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
| | - Ayako Shigeta
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan; Department of Advanced Medicine in Pulmonary Hypertension, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
| | - Miyako Kitazono-Saitoh
- Department of Respirology, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu-City, Tokyo 183-8524, Japan.
| | - Seiichiro Sakao
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
| | - Koichiro Tatsumi
- Department of Respirology (B2), Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-Ku, Chiba 260-8670, Japan.
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Sharma RK, Houston BA, Lima JAC, Cameron DE, Tedford RJ. Never too old for congenital heart disease: sinus venosus atrial septal defect with anomalous pulmonary venous return in an octogenarian. Pulm Circ 2015; 5:587-9. [PMID: 26401261 DOI: 10.1086/682429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/28/2015] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Ravi K Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Duke E Cameron
- Department of Cardiac Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland, USA
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Silva-Klug A, Mauri-Pont M, Martinez-Ruiz M, Sanchez-Hidalgo A. Drenaje venoso pulmonar anómalo y síndrome de Gilbert. Rev Clin Esp 2015; 215:67-9. [DOI: 10.1016/j.rce.2014.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 09/18/2014] [Accepted: 09/21/2014] [Indexed: 11/29/2022]
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Is restrictive atrial septal defect a risk in partial anomalous pulmonary venous drainage repair? Ann Thorac Surg 2014; 97:1664-70. [PMID: 24656957 DOI: 10.1016/j.athoracsur.2014.01.051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/16/2014] [Accepted: 01/17/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND The creation or enlargement of an atrial septal defect (ASD) in partial anomalous pulmonary venous drainage (PAPVD) repair may pose a risk of postoperative pulmonary vein stenosis (PVS), superior vena cava stenosis (SVCS), and atrial rhythm disturbances. METHODS 155 children who underwent repair of right PAPVD between 1990 and 2010 were reviewed. PVS and SVCS were defined by mean gradients on echocardiography: mild=3 to 5 mm Hg; severe=6 mm Hg or higher. Postoperative cardiac rhythms were categorized as sinus, transient nonsinus, and persistent nonsinus rhythms. Outcomes were compared between patients who underwent the creation or superior enlargement of an ASD (group A) and those who did not (group B). RESULTS There was no early or late death. Freedom from any PVS at 15 years after operation was lower in group A than in group B (76.1% vs 96.5%, p=0.002), and no differences were found in freedom from severe PVS (p=0.103), any SVCS (p=0.419), or severe SVCS (p=0.373). Group A patients had more PVS-related reoperations (p=0.022). Nineteen patients had nonsinus rhythm, and 4 patients experienced first-degree atrioventricular block, but no significant difference was found between the groups. Cox regression revealed the creation or superior enlargement of an ASD as a predictor for postoperative PVS (p=0.032). A case-match analysis confirmed a higher risk of PVS in patients with the creation or superior enlargement of an ASD (p=0.018). CONCLUSIONS Late outcomes after repair of PAPVD are excellent. The subgroup that requires creation or superior enlargement of an ASD in repair of a right PAPVD is at a higher risk of late PVS and a subsequent increase in PVS-related reoperation. The presence of restrictive ASD did not increase SVCS, sinus node, or atrial conduction dysfunction.
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Pauwaa S, Farzaneh-Far A. Isolated partial anomalous pulmonary venous return with intact atrial septum: a rare but treatable cause of pulmonary hypertension in adults. ACTA ACUST UNITED AC 2014; 15:830. [DOI: 10.1093/ehjci/jet289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ashrafpoor G, Azarine A, Redheuil A, Cohen S, Raisky O, Mousseaux E, Iserin L. Partial anomalous pulmonary venous return in adults with prior curative congenital heart surgery detected by cross-sectional imaging techniques. Int J Cardiol 2013; 168:e109-10. [DOI: 10.1016/j.ijcard.2013.07.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 07/08/2013] [Indexed: 11/30/2022]
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Sahay S, Krasuski RA, Tonelli AR. Partial anomalous pulmonary venous connection and pulmonary arterial hypertension. Respirology 2013; 17:957-63. [PMID: 22509787 DOI: 10.1111/j.1440-1843.2012.02180.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Isolated partial anomalous pulmonary venous connection (PAPVC) has been implicated as a cause of pulmonary arterial hypertension (PAH); however this condition is often overlooked in the diagnostic work up of patients with PH. We studied the prevalence of PAH both in patients with isolated PAPVC or associated with other congenital heart diseases (CHD) such as atrial septal defect (ASD). We also aimed to identify factors related to the presence of PAH in these patients. METHODS We retrospectively analyzed data from the Adult CHD database at the Cleveland Clinic, U.S.A. between October 2005-2010. We included all patients diagnosed with PAPVC with or without other CHD. We excluded all patients with previous corrective surgeries. RESULTS We identified 14 (2.5%) patients with PAPVC. Group I included patients with PAPVC (with or without patent foramen ovale (PFO)). Group II included patients with PAPVC associated with other CHD. PAH was seen in six (6/14, 42.8%) patients, two (2/7, 28.5%) in group I and four (4/7, 57.1%) in group II (P = 0.3). The mean pulmonary artery pressure in all patients (n = 14) was 29.5 ± 13.8 mm Hg. group I had a mean PAP of 23.6 ± 6.6 mm Hg as compared to 33.7 ± 16.5 mm Hg for group II (P = 0.34). The two patients in group I with PAH had either two anomalous pulmonary veins or a condition (sickle cell disease) that could potentially explain the haemodynamic findings. CONCLUSIONS Patients with PAPVC (with or without PFO) in the absence of other CHD had normal pulmonary arterial pressure (PAP) unless they have two pulmonary veins with anomalous return or associated conditions known to cause PAH.
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Affiliation(s)
- Sandeep Sahay
- Department of Medicine, Akron General Medical Center, Akron, Ohio 44307, USA.
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Sears EH, Aliotta JM, Klinger JR. Partial anomalous pulmonary venous return presenting with adult-onset pulmonary hypertension. Pulm Circ 2012; 2:250-5. [PMID: 22837866 PMCID: PMC3401879 DOI: 10.4103/2045-8932.97637] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Partial anomalous pulmonary venous return (PAPVR) is a rare cause of adult onset pulmonary arterial hypertension (PAH) that can present with a wide spectrum of severity from early childhood throughout adult life. We present two patients with PAH secondary to PAPVR who reflect this range of disease. The diagnosis and treatment of PAPVR and its role in pulmonary vascular disease is discussed. Cardiac and pulmonary physicians should be aware of this entity and its diagnosis and management options.
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Affiliation(s)
- Edmund H Sears
- Division of Pulmonary, Sleep and Critical Care Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Current Role of Imaging in the Diagnosis and Management of Pulmonary Hypertension. AJR Am J Roentgenol 2012; 198:1320-31. [DOI: 10.2214/ajr.11.7366] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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