Clinical Significance of Partial Anomalous Pulmonary Venous Connections (Isolated and Atrial Septal Defect Associated) Determined by Cardiovascular Magnetic Resonance

Abstract

Background: Partial anomalous venous connections (PAPVC) are associated with left to right shunting and right heart dilatation. Identification of PAPVC has increased with widespread use of cross-sectional imaging modalities. However, management strategies are mostly based on expert opinion given the scarcity of data from large series. We aimed to define types and significance of isolated and atrial septal defect (ASD) associated PAPVC detected by cardiovascular magnetic resonance. Methods: We retrospectively reviewed our cardiovascular magnetic resonance database from 2002 to 2018 to identify isolated or ASD-associated PAPVC cases. Results: A total of 215 patients (median age 46 years; range, 6–83) with isolated or ASD-associated PAPVC were identified among 102 135 clinical cardiovascular magnetic resonance studies. Of these, 104 were isolated and 111 were associated with an ASD. Anomalous connection of right upper pulmonary vein was the most common single venous anomaly (99/215), but in the isolated PAPVC group there were more anomalous left than right upper pulmonary veins (39 versus 34). The Qp/Qs was significantly higher for isolated anomalous single right upper pulmonary vein than left upper pulmonary vein (1.6 versus 1.4 respectively; P =0.01) as were right ventricular end-diastolic volumes (113.7±30.9 versus 90 [57–157] mL/m 2 , P =0.004). In the PAPVC with an ASD group, sinus venosus ASDs (82%) were associated with right-sided PAPVCs while both right and left-sided venous anomalies were seen in secundum ASDs (18%). In a substantial number of patients (30 out of 91) with sinus venosus ASDs, PAPVCs were more complex and involved more than a single anomalous right upper pulmonary vein; and in 5 patients with ASD, PAPVC was identified only after the ASD closure. Conclusions: This large series provides descriptive and hemodynamic features for isolated and ASD-associated PAPVCs. Anomalous isolated right upper pulmonary vein may cause a significant shunt (Qp/Qs >1.5). PAPVC associated with sinus venosus and secundum ASDs might be more complex than a single anomalous pulmonary vein and missed before ASD correction.

Does this child just have an atrial septal defect? More potentiality of interventional therapy: A rare case report

“…Patients with ASD tend to been missed diagnoses of PAPVC. The missed diagnosis rate of PAPVC is unclear, but it is more likely to be missed when combined with ASD [ 15 ]. It is estimated that 10 % to 15 % of patients with secondum-type ASD and up to 85 % of patients with sinus venous-type ASD have associated PAPVC [ 16 ].…”

PAPVC with TS—Surgically managed with bilateral ectopic drainage ：a case report and literature review

“…PAPVC is a congenital defect with a prevalence ranging from 0.4-0.7%,which typically manifests as one or more (but not all) pulmonary veins failing to connect to the left atrium [13]. Left-sided PAPVC is often asymptomatic, with only 3% of cases reported [1].…”

Cryoballoon pulmonary vein isolation and left atrial appendage occlusion prior to atrial septal defect closure: A case report

“…Left atrial appendage (LAA) occlusion is performed as an alternative treatment to oral anticoagulation in patients with non-valvular AF[ 3 ]. Atrial septal defect (ASD), as the most common congenital heart disease, may lead to right heart dysfunction and paradoxical embolism[ 4 ]. In patients who suffer from both AF and ASD, cryoballoon PVI combined with ASD closure and the LAA occlusion combined with ASD closure have been reported[ 5 - 7 ].…”