The impact, and surgical implications, of isolated anomalous connection of one pulmonary vein

2007 ◽  
Vol 17 (5) ◽  
pp. 554-556
Author(s):  
Masahiro Koh ◽  
Hideki Uemura ◽  
Koji Kagisaki
Keyword(s):  
Left Atrium ◽  
Pulmonary Vein ◽  
Surgical Repair ◽  
Atrial Septum ◽  
Intact Atrial Septum ◽  
Flow Through ◽  
The Difference ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection ◽  
The Impact

AbstractPartially anomalous pulmonary venous connection of a solitary pulmonary vein in the setting of an intact atrial septum is often subclinical, and the indications for surgical repair are controversial. Here we describe a patient who developed a significant shunt over a period of 10-years. Flow through the anomalously connected pulmonary segment depends on the difference of pressure between the right and left atrium, and may increase with age.

scholarly journals 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

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Atsushi Morishita ◽  
Ikuo Hagino ◽  
Hideyuki Tomioka ◽  
Seiichiro Katahira ◽  
Takeshi Hoshino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Atrium ◽  
Septal Defect ◽  
Surgical Repair ◽  
Interatrial Septum ◽  
Pulmonary Artery Hypertension ◽  
Right Heart ◽  
Intact Atrial Septum ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

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.

scholarly journals 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

2020 ◽  
Author(s):  
Atsushi Morishita ◽  
Ikuo Hagino ◽  
Hideyuki Tomioka ◽  
Seiichiro Katahira ◽  
Takeshi Hoshino ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Atrium ◽  
Septal Defect ◽  
Surgical Repair ◽  
Interatrial Septum ◽  
Pulmonary Artery Hypertension ◽  
Right Heart ◽  
Intact Atrial Septum ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

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.

Surgical repair of total anomalous pulmonary venous connection: Lateral approach

2021 ◽  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Atrial Septal Defect ◽  
Left Atrium ◽  
Septal Defect ◽  
Surgical Repair ◽  
Pleural Cavity ◽  
Pulmonary Veins ◽  
Lateral Approach ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

We describe the lateral approach to the surgical repair of a total anomalous pulmonary venous connection in this video tutorial. The goal of the operation is to create an unobstructed anastomosis between the pulmonary confluence and the left atrium, ligate the systemic venous connections, and close the atrial septal defect. After a median sternotomy and initial dissection of the structures surrounding the heart, cardiopulmonary bypass is initiated by aortobicaval cannulation. The patient is then cooled to attain mild hypothermia (30°C). The heart is arrested by a dose of antegrade cold cardioplegia. The right pleural cavity is opened widely. The heart is retracted and pushed into the right pleural cavity. The vertical vein is ligated near its connection with the innominate vein. An incision is made along the length of the confluence, stopping short of the individual pulmonary veins. The left atrial appendage is retracted, and the left atrium is opened in alignment with the opening in the confluence. The left atrium and the pulmonary confluence are anastomosed widely with 7-0 polypropylene suture material. The heart is put back into the mediastinum. Rewarming is started. The atrial septal defect is closed through the right atrium using a large untreated autologous pericardium patch. The patient is then weaned off cardiopulmonary bypass.

COR TRIATRIATUM WITH INTACT SUBDIVIDING DIAPHRAGM AND PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION TO THE PROXIMAL LEFT ATRIAL CHAMBER (AN UNREPORTED TYPE)

PEDIATRICS ◽  
1971 ◽  
Vol 47 (4) ◽  
pp. 745-750
Author(s):  
James W. Wilson ◽  
Thomas P. Graham ◽  
John A. Gehweiler ◽  
Ramon V. Canent
Keyword(s):  
Left Ventricle ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Cor Triatriatum ◽  
Hypoplastic Left Ventricle ◽  
Inferior Pulmonary Vein ◽  
Superior Pulmonary Vein ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

The clinical, cardiac catheterization, and postmortem findings are presented in a 9-day-old infant with cor triatriatum, anomolous pulmonary venous connections, and a hypoplastic left ventricle. The dorsal accessory left atrial chamber did not communicate with the ventral or proximal left atrium, but did have a small connection with the right atrium. The left superior pulmonary vein connected with the accessory left atrium while the left inferior pulmonary vein connected with the proximal left atrium. The latter pulmonary venous connection has not been described previously in classical cor triatriatum and raises new embryological considerations.

ID: 5: ISOLATED SUPRA-CARDIAC PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION CAUSING RIGHT HEART FAILURE

2016 ◽  
Vol 64 (4) ◽  
pp. 918.2-919 ◽  
Author(s):  
R Sogomonian ◽  
H Alkhawam ◽  
S Lee ◽  
JJ Lieber ◽  
EA Moradoghli Haftevani
Keyword(s):  
Pulmonary Vein ◽  
Superior Vena Cava ◽  
Ventricular Hypertrophy ◽  
Superior Vena ◽  
Vena Cava ◽  
Right Heart Failure ◽  
Right Heart ◽  
Intact Atrial Septum ◽  
The Right ◽  
Anomalous Pulmonary Venous Connection

One of many causes of right heart failure (RHF) is partial anomalous pulmonary venous connection (PAPVC). We present a rare entity of isolated supra-cardiac PAPVC, as right pulmonary vein drains into the superior vena cava (SVC) with intact atrial septum, precipitating RHF.A 55-year-old man with hypertension, diabetes mellitus, coronary artery disease, presenting with syncope. On examination blood pressure was 90/44 mm Hg and heart rate of 44 bpm, lungs were clear on auscultation, jugular venous distension was present, prominent S2 heart sound, and bilateral pitting edema of the lower extremities. Laboratory studies were significant for brain natriuretic peptide (BNP) of 504 pg/mL, troponin I of 0.06 ng/mL, and glycated hemoglobin (HgA1c) of 11.9%. Electrocardiography was significant for left atrial dilation and right ventricular hypertrophy. Transthoracic echocardiography (TTE) showed severe right ventricular dilation, left ventricular hypertrophy, and severe tricuspic regurgitation with pulmonary artery systolic pressure of 85 mm Hg. Additionally, on the TTE ejection fraction was noted to be 55% with no evidence of atrial septal defect (ASD). Cardiac catheterization and computed tomography angiogram (CTA) revealed severe pulmonary hypertension and drainage of the right pulmonary vein into the superior vena cava.We have described a case of an isolated supra-cardiac variant of right pulmonary vein draining into the SVC. ASD is absent in isolated form of PAPVC, our case demonstrated an intact atrial septum in a supra-cardiac variant. Studies have indicated that 82% of patients with PAPVC have an ASD, distinguishing our case as an uncommon entity.Patient was discharged with optimized doses of bumetanide, metoprolol, and was offered surgery for the definitive treatment. Surgical prognosis is excellent and the perioperative mortality rate is less than 0.1%.Abstract ID: 5 Figure 1Cardiac catheterization illustrating drainage from the right pulmonary vein anomalously into the superior vena cava.

Bilateral Partial Anomalous Pulmonary Venous Connection with Intact Atrial Septum

1996 ◽  
Vol 4 (3) ◽  
pp. 181-183 ◽  
Author(s):  
Antonio F Corno
Keyword(s):  
Surgical Repair ◽  
Atrial Septum ◽  
Intact Atrial Septum ◽  
Rare Malformation ◽  
Anomalous Pulmonary Venous Connection

Bilateral partial anomalous pulmonary venous connection is a very rare malformation; its association with intact atrial septum is even more unusual. This report concerns a 5-year-old girl with this condition who underwent successful surgical repair.

Modified Septostomy in d-Transposition of Great Arteries With Aneurysmal and Intact Atrial Septum

2019 ◽  
Vol 10 (6) ◽  
pp. 789-790
Author(s):  
Konstantinos S. Mylonas ◽  
Aphrodite Tzifa
Keyword(s):  
Prenatal Diagnosis ◽  
Atrial Septal Defect ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Septal Defect ◽  
Arterial Switch Operation ◽  
Atrial Septum ◽  
Transposition Of Great Arteries ◽  
Intact Atrial Septum ◽  
Switch Operation

A male term patient was delivered electively due to prenatal diagnosis of d-transposition of great arteries. Postpartum arterial saturation measured 65%. Transthoracic echo revealed an extremely aneurysmal atrial septum with no obvious atrial septal defect. Emergency Rashkind procedure was deemed necessary. Multiple attempts to advance the septostomy catheter to the left atrium resulted in tenting of the septum with no obvious interatrial flow. The aneurysmal septum was therefore advanced with caution and perforated within the left lower pulmonary vein under echocardiographic guidance. The patient tolerated the procedure well and a successful arterial switch operation was performed eight days later. Stabilization and perforation of an aneurysmal, intact atrial septum within the pulmonary vein may be a helpful maneuver to complete the Rashkind procedure.

scholarly journals P1729 Abnomral course of pulmonary vein causing right heart dilatation

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
O T Osman ◽  
G Abushahba ◽  
W Francis ◽  
S Elbdri ◽  
E Khalifa
Keyword(s):  
Pulmonary Vein ◽  
Right Atrium ◽  
Venous Return ◽  
Pulmonary Veins ◽  
Atrial Septum ◽  
Ct Venography ◽  
Intact Atrial Septum ◽  
Anomalous Pulmonary Venous Return ◽  
The Right ◽  
Cardiac Shunt

Abstract Funding Acknowledgements None Introduction Partial anomalous pulmonary venous return is a rare congenital cardiac anomaly that usually involves the right pulmonary vein and an atrial septal defect. It is accounted for 0.7%. 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 report a case of a young female, incidentally found to have a right upper pulmonary vein draining into the right atrium, confirmed by TOE and CT Venography pulmonary, with moderate right ventricular enlargement, without pulmonary hypertension, intra-cardiac shunt or accompanied congenital anomaly. A decision of surgical correction was made. We conclude that it is important to suspect PAPVC in patients with right ventricular volume overload, even in absence of ASD. Case presentation A 26-year-old female, not known to have any chronic illness. She was referred because of poor appetite and low weight, to cardiology evaluation for accidental murmur finding during examination. She had no other symptoms. The TOE was done which showed left pulmonary veins are normal, the right lower pulmonary vein is normal, and there is high suspicion of aberrant right upper pulmonary vein draining in the right atrium, no evidence of intra-cardiac shunt. CT Venography pulmonary revealed anomalous (Giant) right superior pulmonary vein to the superior vena cava and draining to the right atrium. Figure 1. Patient was referred for surgical correction. Discussion Partial anomalous pulmonary venous return is a type of left to right shunt. It is a rare congenital abnormal cardiac defect in which the pulmonary veins draining into the right atrium (RA) directly or indirectly by venous connection. Its accounted for 0.4 to 0.7%. However, as this rate is based upon autopsy data, the true prevalence of PAPVR may actually be higher. PAPVR is frequently associated with other congenital heart disease, most commonly ASD, in >75% of patients. It is estimated that 10% to 15% of patients with ASD and up to 85% of patients with sinus venosus ASD have PAPVC. Exclusive of ASD, other more complex cardiac malformations occur in ∼20% of patients. PAPVR can also be an isolated defect with intact atrial septum. TOE is more sensitive than TTE in detecting PAPVR. A potential limitation of echocardiography is the availability of acoustic windows. If all four PVs are not identified emptying into the left atrium on TEE, CCT and CMR may provide complementary data . CONCLUSION In conclusion, missed diagnosis always occurs in PAPVR, the debauched and blood flow of pulmonary vein should be over-viewed carefully during TEE examination. In a patient with unexplained RV enlargement PAPVC (one or more pulmonary veins) should be considered in the differential diagnosis. Multi-modality cardiac imaging using echocardiography, CT angiography and CMR may provide a comprehensive noninvasive evaluation of PAPVC. Abstract P1729 Figure. Fig1 TOE (Top),CT (Bottom) of RUPV

Arterial Stiffness Assessed by Cardio-Ankle Vascular Index in Patients With Abdominal Aortic Aneurysm and Its Alterations After Treatment

2021 ◽  
pp. 153857442110232
Author(s):  
Spyridon N. Mylonas ◽  
Konstantinos G. Moulakakis ◽  
Nikolaos Kadoglou ◽  
Constantinos Antonopoulos ◽  
Thomas E. Kotsis ◽  
...  
Keyword(s):  
Arterial Stiffness ◽  
Surgical Repair ◽  
Open Repair ◽  
Abdominal Aortic ◽  
Gender And Age ◽  
Baseline Values ◽  
The Difference ◽  
The Impact ◽  
Repair Group

Purpose: The aim of the present study was to investigate a potential difference on the arterial stiffness among aneurysm patients and non-aneurysm controls, as well as to explore potential changes between patients treated either with endovascular or open repair. Materials and Methods: A 110 patients with an infrarenal AAA were prospectively enrolled in this study. Fifty-six patients received an EVAR, whereas 54 patients received an open surgical repair. Moreover, 103 gender and age-matched subjects without AAA served as controls. The cardio-ankle vascular index (CAVI) was applied for measurement of the arterial stiffness. Results: CAVI values were statistically higher in the AAA patients when compared with control subjects. Although at 48 hours postoperatively the CAVI values were increased in both groups when compared to baseline values, the difference in CAVI had a tendency to be higher in the open group compared to the endovascular group. At 6 months of follow up the CAVI values returned to the baseline for the patients of the open repair group. However, in the endovascular group CAVI values remained higher when compared with the baseline values. Conclusion: Patients with AAAs demonstrated a higher value of CAVI compared to healthy controls. A significant increase of arterial stiffness in both groups during the immediate postoperative period was documented. The increase in arterial stiffness remained significant at 6 months in EVAR patients. Further studies are needed to elucidate the impact of a decreased aortic compliance after stentgraft implantation on the cardiac function of patients with AAA.

Sign in / Sign up

Export Citation Format

Share Document