BackgroundPartial 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 presentationA 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.ConclusionsThe 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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Nowadays, percutaneous coronary intervention (PCI) is an established procedure, and annually more than 500,000 coronary stents are implanted in the United States 1). However, most physicians hardly recognize that a coronary stent can be a potential source of infection and that the risk may last for several years. Stent infection is extremely rare and difficult to identify. As a result, delay in definite diagnosis could lead to even death. Mortality rate of coronary stent infection is reported to be as high as 40% even with surgery 2). Therefore, prompt diagnosis is essential to save patients. In this report, we describe a case of stent infection that occurred 8 years after implantation. To our knowledge, this is the longest reported interval between PCI and infection. Unfortunately , as we did not suspect very late stent infection, the true diagnosis was delayed by more than a few weeks despite repeated examinations using multiple imaging modalities. II. Case report A 66-year-old woman with a history of kidney transplantation and coronary disease presented with fever and general fatigue. She was status post repeated PCI with bare-metal stents (BMS) in the right coronary artery (RCA) at the ages of 57 years, 58 years, and 59 years, and drug-eluting stents (DES) in the left anterior descending coronary artery at the age of 57 years. She had been taking immunosuppressant medications (methyl prednisolone, mycophenolate mofetil, and tacrolimus) for 8 years since kidney transplantation. Her temperature was 39.5 °C and she had an elevated white cell count (16,450/μl), C-reactive protein level (19.67 mg/dl), and procalcitonin level (5.23 ng/ml). Blood cultures grew Staphylococcus aureus sensitive to methicillin (MSSA). At this time, whole-body computed tomography (CT) scan could not identify the source of bacteremia (Fig. 1a). On hospital day 2, she complained of difficulty in speaking. She underwent brain magnetic resonance imaging (MRI) that re