Isolated supra-cardiac partial anomalous pulmonary venous connection causing right heart failure

Isolated Partial Anomalous Pulmonary Venous Connection: Development of Volume Overload and Elevated Estimated Pulmonary Pressure in Adults

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.

Comprehensive Cross-sectional Imaging of the Pulmonary Veins

The pulmonary veins carry oxygenated blood from the lungs to the heart, but their importance to the radiologist extends far beyond this seemingly straightforward function. The anatomy of the pulmonary veins is variable among patients, with several noteworthy variant and anomalous patterns, including supernumerary pulmonary veins, a common ostium, anomalous pulmonary venous return, and levoatriocardinal veins. Differences in pulmonary vein anatomy and the presence of variant or anomalous anatomy can be of critical importance, especially for preoperative planning of pulmonary and cardiac surgery. The enhancement or lack of enhancement of the pulmonary veins can be a clue to clinically important disease, and the relationship of masses to the pulmonary veins can herald cardiac invasion. The pulmonary veins are also an integral part of thoracic interventions, including lung transplantation, pneumonectomy, and radiofrequency ablation for atrial fibrillation. This fact creates a requirement for radiologists to have knowledge of the pre- and postoperative imaging appearances of the pulmonary veins. Many of these procedures are associated with important potential complications involving the pulmonary veins, for which diagnostic imaging plays a critical role. A thorough knowledge of the pulmonary veins and a proper radiologic approach to their evaluation is critical for the busy radiologist who must incorporate the pulmonary veins into a routine "search pattern" at computed tomography (CT) and magnetic resonance imaging. This article is a comprehensive CT-based imaging review of the pulmonary veins, including their embryology, anatomy (typical and anomalous), surgical implications, pulmonary vein thrombosis, pulmonary vein stenosis, pulmonary vein pseudostenosis, and the relationship of tumors to the pulmonary veins. Online supplemental material is available for this article. ^©RSNA, 2017.