Incidental partial anomalous pulmonary venous connection in left lung cancer

We present the case of a 79-year-old woman with partial anomalous pulmonary venous connection (PAPVC), discovered incidentally during upper left division segmentectomy for primary lung cancer. The left superior pulmonary vein originated from the hilum of the upper left lobe and flowed into the left brachiocephalic vein. The left inferior pulmonary vein was connected normally, and neither atrial septal defect nor other anomalous condition was present. Upper left lobectomy with ligation of the anomalous connected vein was performed, as the lingual segment was anatomically difficult to retain. Although this type of PAPVC is extremely rare, it is advisable to exercise caution when performing lung resection with the potential for PAPVC in mind.     

Incidental discovery of a partial anomalous pulmonary venous connection in the surgical critical care unit

Routine chest roentgenogram to confirm catheter placement in a postsurgical patient showed a left-sided internal jugular central venous catheter that did not appear to cross the midline. Arterial blood gas samples showed greater oxygenation from the central catheter as compared with the peripheral arterial sample. However, a transduced waveform showed a venous tracing and pressure. Computed tomographic scan of the thorax without intravenous contrast showed a partial anomalous pulmonary venous connection with drainage of the left upper lobe pulmonary vein into the innominate vein.     

Successful pulmonary resection of lung cancer in a patient with partial anomalous pulmonary venous connection: report of a case

A rare case of the potentially grave combination of lung cancer and partial anomalous pulmonary venous connection (PAPVC) is described. PAPVC would cause many problems following major lung resection, even in a preoperatively asymptomatic patient, because of the inevitable development of right ventricular failure as a result of right ventricular volume overload caused by the left-to-right physiologic shunt. On the other hand, if a patient has primary lung cancer, anatomical resection should be done to achieve curative treatment. We successfully performed a left lower lobectomy for lung cancer in a patient with abnormal venous drainage in the left upper lobe, with simultaneous correction of a PAPVC. Received: August 17, 2001 / Accepted: March 5, 2002     

Repair of partial anomalous pulmonary venous connection with a minimal atriotomy.

We present an alternative surgical technique for the repair of a partial anomalous pulmonary venous connection to the higher segment of the superior vena cava. Although the atriotomy is limited in this technique, a sufficiently large systemic venous chamber overlapping to the outside of the superior vena cava can be created.     

Left partial anomalous pulmonary venous connection found during a lobectomy for lung cancer: Report of a case

We report herein the case of a 68-year-old man in whom a partial anomalous pulmonary venous connection (PAPVC) was found during an operation for primary lung cancer. The preoperative clinical findings did not suggest a vascular shunt, and intraoperatively the anomalous vein was seen to drain only from the left upper lobe into the left innominate vein. The lower pulmonary vein connected normally, and there was no atrial septal defect nor any other anomalous condition. A left upper lobectomy with ligation of the anomalous connected vein was performed uneventfully. This type of PAPVC is extremely rare, and is especially noteworthy because there were no clinical signs.     

Total anomalous pulmonary venous connection

Repair of total anomalous pulmonary venous connection was performed on 31 patients aged 12 days to 14 years (18 less than 6 months). The connection type was supracardiac in 20 cases, cardiac in nine, infracardiac in one case and mixed in one. Deep hypothermia and circulatory arrest were used in 23 cases (74%). In supracardiac type cases the atrial septal defect was closed through the left atriotomy, without enlargement of the left atrium. Extubation in the operating room was possible in 26 cases (84%). Three patients (9.6%) died, one (with connection to the coronary sinus) soon after operation, due to a management error, another (with connection to the right superior vena cava) of pulmonary edema, and an infant with mixed-type connection 1 week postoperatively, presumably from an arrhythmia. No patient required reoperation because of late pulmonary venous stenosis. There were no late deaths. The technique of elevating the cardiac apex provided excellent exposure in the supracardiac and infracardiac types. Progressively earlier referral during the study period facilitated prompt operation and improved patient salvage.     

Total anomalous pulmonary venous connection

Total anomalous pulmonary venous connection (TAPVC) was repaired by operation in 20 infants during a 101/2-year period (1972 to 1983). Five patients died following operation. Factors that most affected mortality were the condition of the patient prior to repair, the year of operation, and the technique used for repair. Operative mortality before 1976 was significantly different from that after 1976 (57% [4/7] versus 8% [1/13], respectively; p less than 0.04). Prior to 1976, the several techniques used for anastomosis of the left atrium to the common pulmonary vein involved displacement of the heart from its anatomical position. After 1976, a standard approach using a right atriotomy for access was adopted for all such repairs. Intracardiac type of TAPVC was repaired by pericardial patch to direct blood flow through the atrial septal defect to the left atrium. Supracardiac and infracardiac types were repaired by enlarging the atrial septal defect so that a transverse incision through the back of the left atrium was exactly overlying the pulmonary vein posteriorly. A large anastomosis of the left atrium and common pulmonary vein was made with the heart in its natural anatomical position, which eliminates the possibility of distortion of the anastomosis. A pericardial patch was used to close the atrial septal defect. This experience suggests that the right transatrial approach of creating an anatomically correct anastomosis of the left atrium to the common pulmonary vein is an important factor in reducing operative mortality in patients with TAPVC.     

Total anomalous pulmonary venous connection

Recently the surgical results of simple (isolated) total anomalous pulmonary venous connection have improved markedly, and even the most severely affected patients presenting with marked hypoxia soon after birth have become salvagable partly due to the perioperative use of nitric oxide and extracorporeal membrane oxygenation. However, the outcome after complex surgery, particularly in asplenia, is still very poor in newborns. Common pulmonary vein atresia is still an ominous diagnosis and according to the literature only a few patients have survived surgery. The results of reoperation for postoperative pulmonary vein stenosis are also poor, although the good results of the "sutureless technique" which have recently been reported are encouraging. Prenatal diagnosis using echocardiography is difficult, but postnatal diagnosis using echocardiography and magnetic resonance imaging is usually precise and can obviate the need for cardiac catheterization which often aggravates the hypoxic status in critically ill infants.     

Partial anomalous pulmonary venous connection in right lung cancer: Report of a case

A partial anomalous pulmonary venous connection (PAPVC) is an uncommon congenital anomaly which is frequently associated with congenital heart disease such as an atrial-level shunt. This report documents the case of an 81-year-old man with PAPVC which was incidentally discovered during a right upper lobectomy for lung cancer. Surgery was performed through a minithoracotomy of an auscultatory triangle using a video-assisted procedure (video-assisted thoracic surgery: VATS). Although the ramus lobi medii was connected normally, the right superior lobe vein was found to drain into the superior vena cava. The surgery was successful, and the patient had an uneventful postoperative course. Asymptomatic PAPVC without an atrial septal defect (ASD) is extremely rare. If the PAPVC is located in a different lobe, a pulmonary resection for lung cancer would precipitate an adverse outcome without a correction of the PAPVC. Surgeons should therefore be cautious regarding the potential existence of a PAPVC when a patient undergoes surgical procedures, especially VATS, for lung cancer.     

Pulmonary venous obstruction after the Williams procedure for partial anomalous pulmonary venous connection

A 54-year-old man was admitted to our hospital because of chest discomfort. Cardiac catheterization revealed partial anomalous pulmonary venous connection with an intact atrial septum. The right upper pulmonary vein (RUPV) drained into the upper segment of the superior vena cava (SVC). Using the Williams procedure, an atrial septal defect (ASD) was created and a fresh autologous pericardial patch was used to fashion a new pulmonary vein return route from SVC to the ASD. Although the patient was stable after the procedure, he was admitted again 6 months later because of obstruction of RUPV. At reoperation, it was found that the previous pulmonary vein route was obstructed and that the pericardial baffle had adhered to the atrial septum above the ASD. The shrunken and thickened pericardial baffle was removed and the orifice of the ASD was extensively enlarged, after which an expanded polytetrafluoroethylene (ePTFE) patch was used as a new baffle. After the reoperation, the patient's condition improved.     

Bilateral partial anomalous pulmonary venous connection; report of a case

We have experienced a case of bilateral partial anomalous pulmonary venous connection with a fossa ovalis type of atrial septal defect and pulmonary stenosis. The right upper pulmonary vein returned to the superior vena cava and the left upper pulmonary vein returned to the left innominate vein via the vertical vein. The atrial septal defect was enlarged and the right upper pulmonary vein was baffled into the left atrium with an equine pericardial patch. The left upper pulmonary vein was divided and anastomosed to the left atrial appendage. Pulmonary commissurotomy was also done for concomitant pulmonary stenosis. Postoperative course of the patient was excellent with constantly normal sinus rhythm. Angiography 2 weeks after operation showed no evidence of pulmonary venous obstructions on both sides.