A Case Report Looking at An Incidental Finding of A Partial Anomalous Pulmonary Venous Connection (PAPVC) Using Magnetic Resonance Angiography (MRA)
Background: Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital defect where one or more of the pulmonary veins drain to the right atrium or its tributaries. This may cause a left to right shunt (LTRS) which may need surgical management. This case looks at a 58-year-old lady with a background of Non-ST elevation myocardial infarction (NSTEMI) and co-morbidities, who presented with central chest pain. Cardiac magnetic resonance angiogram (MRA) was used in the diagnosis and management of her PAPVC.
Results: On MRA an incidental finding of PAPVC was found (left upper pulmonary vein drained into brachiocephalic vein) creating a LTRS which wasn’t substantial (Qp/Qs <1.5). Delayed hyper-enhancement of the septal regions indicated a myocardial infarction, however the right and left ventricles remained unremarkable. Despite being asymptomatic, this patient was followed up, with informed consent, and if symptoms developed, she would be considered for PAPVC surgery.
Conclusion: Studies showed PAPVC patients developing symptoms or LTRS as candidates for operation. However, the issue lied in using multimodality imaging to diagnose the PAPVC, as one modality was insufficient. Physicians should be aware of rare anomalies like PAPVC and should follow up these patients closely in case of worsening of the LTRS, in which case surgical correction may be possible. Overall, PAPVC i) can be overlooked ii) diagnosis requires multimodality imaging iii) constant follow up and iv) may be operable.
2. Kottayil, Brijesh P., et al. "Anomalous pulmonary venous connection to superior vena cava: Warden technique." European Journal of Cardio-Thoracic Surgery 39.3 (2011): 388-391.
3. Nakahira, Atsushi., et al. "Partial anomalous pulmonary venous connection to the superior vena cava." The Annals of thoracic surgery 82.3 (2006): 978-982.
4. Kobayashi, Daisuke, Derek A. Williams, and Amanda L. Cook. "Mixed-type total anomalous pulmonary venous connection." Pediatric cardiology 31.6 (2010): 929-930.
5. Ho VB, Bakalov VK, Cooley M, Van PL, Hood MN, Burklow TR, et al. “Major vascular anomalies in Turner syndrome: prevalence and magnetic resonance angiographic features.” Circulation. 2004; 110:1694–700.
6. Kadam S. “Partial Anomalous Pulmonary Venous Connection.” International Education and Research Journal. 3.9 (2017): 20-21.
7. Babb JD,McGlynn TJ, Pierce WS et al. “Isolated partial anomalous venous connection: a congenital defect with late and serious complications.” Annals of Thoracic Surgery. (1981);; 31: 540–1
8. Sears, Edmund H., Jason M. Aliotta, and James R. Klinger. "Partial anomalous pulmonary venous return presenting with adult-onset pulmonary hypertension." Pulmonary circulation 2.2 (2012): 250.
9. Edwin F. Left-sided partial anomalous pulmonary venous connection – should diagnosis lead to surgery?. Interactive CardioVascular and Thoracic Surgery (2010); 11.6.
10. Ucar T, Fitoz S, Tutar E, Atalay S, Uysalel A. Diagnostic tools in the preoperative evaluation of children with anomalous pulmonary venous connections. International Journal of Cardiovascular Imaging (2008); 24.
11. Prasad, Sanjay K., et al. "Role of magnetic resonance angiography in the diagnosis of major aortopulmonary collateral arteries and partial anomalous pulmonary venous drainage." Circulation. 109.2 (2004): 207-214.
12. Sahay S, Krasuski R, Tonelli A. “Partial anomalous pulmonary venous connection and pulmonary arterial hypertension.” Respirology. 17 (2012): 957-963.
13. Napoleone C, Mariucci E, Angeli E, Oppido G, Gargiulo G. Sinus node dysfunction after partial anomalous pulmonary venous connection repair. The Journal of Thoracic and Cardiovascular Surgery 147.5 (2014).
14. Takei H, Suzuki K, Asamura H, Kondo H, Tsuchiya R. Successful Pulmonary Resection of Lung Cancer in a Patient with Partial Anomalous Pulmonary Venous Connection: Report of a Case. Surgery Today 32 (2002).
15. Asakura K, Izumi Y, Kohno M, Watanabe M, Arai T, Nomori H. Partial Anomalous Pulmonary Venous Connection Associated with Lung Cancer in the Same Lobe: Report of a Case. Annals of Thoracic and Cardiovascular Surgery 20(2014).
Copyright (c) 2018 Iqra Qamar, Mohammad Waleed, Dr.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to email@example.com
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to firstname.lastname@example.org