Partial anomalous pulmonary venous drainage to persistent left superior caval vein: Or is it a “levoatriocardinal vein”?

Abstract

We report a case of a 3-month-old girl with pulmonary atresia and intact ventricular septum where computed tomography (CT) angiography demonstrated an anomalous venous channel connecting the left brachiocephalic vein to the left atrium and all the pulmonary veins draining the left lung were seen draining individually into this channel. The case highlights the differential diagnosis of such veno-venous connections between the systemic and pulmonary venous circulations as well as the growing role of CT angiography in the understanding of these venous anomalies in the setting of complex congenital heart diseases.

Is it really a levoatrial cardinal vein?

“…Many of the cases now coming to attention are now proving, as in the second reported case, 2 to be more than pulmonary‐to‐systemic collateral channels, being found in individuals without left‐sided obstructive lesions. Of the cases reported recently, three were recognized subsequent to computed tomographic interrogation in our own institute 5–7 . We anticipate that, with the increasing use of computed tomographic interrogation, the collateral channels will be encountered with increasing frequency.…”

“…In the first example, there was mitral atresia, and the collateral channel was recognized as providing overflow from the left atrium in the setting of an intact atrial septum 1 . In the second case, reported the next year, the ventriculo‐arterial connections were discordant, with aortic coarctation, but the significant finding was “an anomalous jugulopulmonary vein of extreme interest.” As the authors of the latter report explained, the vein in question had “no counterpart in comparative anatomy,” and “no case had been found in which the systemic veins are directly connected to the pulmonary ventricle.” 2 These descriptions, now nearly 100 years old, are pertinent to the rash of cases recently reported within the pages of the journal with the so‐called “levoatrial cardinal vein.” 3–7 This venous channel, identical to the cases discussed above, was brought to prominence by the writings of Edwards and his colleagues during the 1950s 8–10 . in reality, the vein is neither “levo,” nor “atrial,” nor “cardinal.” Despite these facts, it is almost certainly the title by which it will continue to be described.…”

“…2 These descriptions, now nearly 100 years old, are pertinent to the rash of cases recently reported within the pages of the journal with the so-called "levoatrial cardinal vein." [3][4][5][6][7] This venous channel, identical to the cases discussed above, was brought to prominence by the writings of Edwards and his colleagues during the 1950s. [8][9][10] in reality, the vein is neither "levo," nor "atrial," nor "cardinal."…”

“…Of the cases reported recently, three were recognized subsequent to computed tomographic interrogation in our own institute. [5][6][7] We anticipate that, with the increasing use of computed tomographic interrogation, the collateral channels will be encountered with increasing frequency. The question must be posed, therefore, as to whether they are truly "levoatrial cardinal veins," or no more than pulmonary-to-systemic venous collateral channels?…”