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).
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