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 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.     

Lung cancer which accompanies anomalous venous connections, pulmonary and systemic-partial anomalous pulmonary venous connection and persistent left superior vena cava: report of 2 cases

We report the cases of a left partial anomalous pulmonary venous connection (PAPVC) and a persistent left superior vena cava (PLSVC), combined with primary lung cancer. Our case of PAPVC, the anomalous pulmonary vein originated from the hilum of the left upper lobe flowed into the left brachiocephalic vein. A left lower lobectomy was performed uneventfully without correcting the anomalous vein. And a case of PLSVC, the left superior vena cava flowed into the right superior vena cava, running under the aortic arch. A left upper lobectomy and mediastinal lymph node dissection was performed in safety. Although PLSVC was detected by chest computed tomography (CT) before operation, PAPVC was noticed intraoperatively in our case. We should keep in mind the possibility of variations of pulmonary vessel distribution, especially PAPVC located in a different lobe for resection, when undertaking lung resection.     

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.     

High origin of the right coronary artery with partial anomalous pulmonary venous connection to the left superior caval vein in tetralogy of Fallot

The prevalence of anomalous origin of coronary artery in tetralogy of Fallot has been reported to be around 4% to 6%. The association of high take-off of the right coronary artery from the distal part of the ascending aorta in tetralogy of Fallot in the presence of a partial anomalous pulmonary venous connection (PAPVC) to the left superior caval vein draining into the left atrium is not known to the best of our knowledge. We herein describe such a case when the anomalous right coronary artery and the PAPVC were detected incidentally during intracardiac repair; signifying the importance of a thorough assessment of the anatomy before surgery.     

Partial anomalous connection of both superior pulmonary veins

Several patterns of anomalous pulmonary venous drainage have been described in the literature, and bilateral partial pulmonary anomalous vein connection (PAPVC) has been described as a rare congenital cardiac anomaly. We report an unusual type of bilateral PAPVC, involving both the superior right and left pulmonary veins draining into the left brachiocephalic vein in a young adult who was symptomatic with dyspnea and a dry cough.     

A surgically treated case of partial anomalous pulmonary venous connection to the right atrium, diagnosed by magnetic resonance imaging

We report a successful surgical repair of a 33-year-old male with partial anomalous pulmonary venous connection (PAPVC) to the right atrium and pulmonary valve stenosis. This case was diagnosed using Magnetic Resonance Imaging (MRI). The findings of MRI clearly showed an abnormal development of the atrial septum far to the left, and the right lower pulmonary vein connected to the right atrium. An embryologic explanation of PAPVC can be provided in many cases by persistent communication between pulmonary veins and systemic veins. However, the MRI findings of this case support the suggestion of Neill that an abnormal development of the atrial septum far to the left provides an embryologic explanation for PAPVC to the right atrium. Preoperative MRI study of PAPVC to the right atrium prove to be of great value in preventing accidental over-cutting of the posterior atrial wall during surgical correction.     

Surgical correction for partial anomalous pulmonary venous connection with intact atrial septum without using extracorporeal circulation

A 13-year-old boy with partial anomalous pulmonary venous connection (PAPVC) having an intact atrial septum (IAS) is reported. He had open heart surgery 3 years ago at another hospital, but the cardiac septum was intact and PDA was ligated. After his discharge, cardiomegaly and increased right pulmonary vasculature were seen in chest roentgenograms. Our cardiac catheterization data and pulmonary angiograms showed that he had a PAPVC with IAS. Surgical correction was accomplished by utilizing a polytetrafluoroethylene graft with external ring support and interposing it between the right upper pulmonary vein and the left atrium during thoracotomy without the need for extracorporeal circulation. The postoperative course was uneventful and he was discharged on the 14th postoperative day. At 3 months postoperatively, radionuclide studies demonstrated no evidence of pulmonary congestion or graft obstruction. To our knowledge, this is the first clinical report of prosthetic replacement of the pulmonary venous pathway with graft patency demonstrated postoperatively.     

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.     

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     

Polysplenia with anomalous pulmonary venous drainage to right atrium caused by atrial septal displacement; report of a case

A 3-year-old girl with polysplenia, atrial septal defect (ASD), and partial anomalous pulmonary venous connection (PAPVC) was admitted to our unit to have total correction. Preoperative three-dimensional computed tomography (3D-CT) and transesophageal echo (TEE) showed that the pulmonary veins were connected with what normally constitutes the posterior wall of the left atrium, but right pulmonary veins became incorporated into the right atrium because of the atrial septal displacement. In the procedure, intracardiac inspection revealed absence of septum secondum and leftward deviation of septum primum. Deviated septum primum was incised at the posterior edge and shifted rightward to incorporate right pulmonary veins into the left atrium. ASD was closed using autologous pericardial patch. This type of PAPVC was rare and preoperative 3D-CT and TEE was quite useful in evaluating unique anatomical characteristics.     

Simultaneous three-port thoracoscopic surgery for bilateral lung cancers with a pulmonary vein anomaly: A case report

IntroductionSimultaneous resection of bilateral lung cancers is technically challenging but may be preferable to a staged procedure in patients with a partial anomalous pulmonary venous connection (PAPVC) in an affected lobe. We performed single-stage resection of bilateral lung cancers in a patient with a PAPVC.Presentation of caseA 73-year-old man was diagnosed as having bilateral lung cancers (right, cT3N1M0, stage IIIA and left, cT2aN0M0, stage IB). Left upper trisegmentectomy was performed, followed by right upper lobectomy with deep wedge bronchoplasty. A PAPVC was found incidentally in the affected right upper lobe and successfully divided. The postoperative course was uneventful and he commenced chemoradiotherapy.DiscussionResection of the PAPVC, which was located in the same lobe as the lung cancer, would have mitigated load increase in the right heart and may have alleviated the adverse effects of bilateral lung resection. Moreover, the single-stage procedure likely shortened the overall duration of treatment.ConclusionSingle-stage bilateral thoracoscopic resection may have advantages over staged procedures in some patients with PAPVCs.     

Mixed type of total anomalous pulmonary venous return: a rare pattern of pulmonary venous drainage]

The occurrence of multiple drainage sites in total anomalous pulmonary venous return (TAPVR) has important implication in preoperative diagnosis and surgical treatment. We report a rare pattern of pulmonary venous drainage with the right upper pulmonary vein draining into the innominate vein and the other three pulmonary veins into the portal vein (Ib + III type). The preoperative diagnosis was made by echocardiography and confirmed by angiography. In operation, an anastomosis was made between the common pulmonary vein and the left atrium through posterior approach, but the right upper pulmonary vein was left uncorrected because the anomalously draining blood flow of a single pulmonary vein was about 20% of total pulmonary blood flow. The postoperative course was uneventful, however, the long-term follow-up is mandatory because of the right upper pulmonary vein being left uncorrected.     

Urgency of operation in infracardiac total anomalous pulmonary venous connection

BACKGROUND: Because the tendency for pulmonary venous obstruction in the infracardiac type of total anomalous pulmonary venous connection may be partially dependent on the connection of the descending vein to the portal vein, the inferior vena cava, or one of their tributary vessels, we reviewed our surgical experience with various subtypes of infracardiac total anomalous pulmonary venous connection. METHODS: The urgency of operation in 4 neonates with infracardiac total anomalous pulmonary venous connection was reviewed. RESULTS: Two patients with pulmonary venous obstruction in whom the descending vein connected to the portal vein were operated on immediately with successful outcome. One patient who had become critically ill after the ductus venosus had closed died before operation could be undertaken. One patient in whom the descending vein connected to the left hepatic vein was operated on electively with successful outcome. CONCLUSIONS: In hemodynamically stable patients with no clinical or echocardiographic signs of pulmonary venous obstruction, some form of differentiation with regard to urgency of operation may be appropriate. When the descending vein connects to the inferior vena cava or a hepatic vein, the operation may be performed on a semi-elective basis. In contrast, when the descending vein connects to the portal vein or the ductus venosus, operation should generally not be delayed because of the high likelihood of obstruction.     

An anomalous segmental vein of the left upper lobe of the lung: preoperative identification by three-dimensional computed tomography pulmonary angiography

A number of variations in the pulmonary arteries and veins have been documented, and the information is very important for performing a safe lung resection. This report describes a case of an anomalous segmental vein of the left upper lobe of the lung. The patient was a 75-year old male who was suspected to have lung cancer in the left upper lobe. A contrast-enhanced computed tomography showed a vessel behind the left lower bronchus. A three-dimensional computed tomography angiography demonstrated that it was an anomalous vein for the apicoposterior segment of the left upper lobe of the lung, draining into the left inferior pulmonary vein. The aberrant vein was readily identified during surgery and was divided without injury, and a left upper lobectomy was successfully performed. Aberrant pulmonary veins for the superior segment of the right upper lobe of the lung are rarely observed, and the same kind of anomaly on the left side has not been reported.     

An alternative method for repair of partial anomalous pulmonary venous connection to the superior vena cava

The surgical management of 15 patients with partial anomalous pulmonary venous connection (PAPVC) to the high superior vena cava (SVC) is described. This new technique redirects the anomalous pulmonary venous flow into the left atrium through the cardiac end of the SVC, transected and oversewn above the anomalous pulmonary vein or veins, by coaptation of the atrial septal defect (or of the surgically created septal defect in patients with an intact atrial septum) to the intracardiac orifice of the SVC. Normal SVC-right atrial flow is reconstituted by atriocavoplasty to the cephalad portion of the transected SVC. A 31-year-old woman with severe pulmonary hypertension died early in the series; this was the only death. Surviving patients enjoy full activity. Except for one symptomatic SVC obstruction due to technical error (since relieved), this technique has achieved total correction of these congenital defects with marked reduction in the undesirable postoperative sequelae often associated with other methods of repair.     

Mixed type total anomalous pulmonary venous connection with the left upper pulmonary vein draining into the innominate vein and the other pulmonary veins into the coronary sinus--surgical correction in 2 infants

Surgical repair of the mixed type total anomalous pulmonary venous connection (TAPVC) in infancy is known to be difficult. In this report, experience of two infants with the mixed type TAPVC with the left upper pulmonary vein (PV) draining into the innominate vein and the other PVs into the coronary sinus (IIa + Ia (left upper PV) type TAPVC) is presented. In such cases, it has been said that the left upper PV should be left uncorrected, but we anastomosed the left upper PV, that was thin and fragile, to the left atrium and corrected all the other anomalous PVs. The results were satisfactory. Recently, Extra-Corporeal circulation, microsurgery, and other techniques have significantly progressed, so we consider that the anastomosis is possible in most infants with IIa + Ia (left upper PV) type TAPVC. In the future, careful clinical follow-up and repeat catheterizations should be done, and we'd like to examine the long term patency of the left upper PV.     

Total anomalous pulmonary venous connection to the portal and splenic vein associated with unilateral hypoplasia of pulmonary veins

Total anomalous pulmonary venous return (TAPVR) represents a rare congenital anomaly with wide anatomical and physiological variability. We report a case of a newborn with a challenging form of obstructed infracardiac TAPVR, in whom left and right pulmonary veins drained separately into the portal system. The right pulmonary venous sinus connected to the left branch of the portal vein, whereas the left venous sinus connected to the splenic vein. Surgical repair consisted of the creation of a common retrocardiac venous trunk which was anastomosed to the left atrium. The postoperative course was characterized by persisting congestion of the right lung. Two months later, right pulmonary vein hypoplasia was successfully enlarged with autologous pericardium.     

Surgical Treatment of Partial Anomalous Pulmonary Venous Connection of the Left Lung (It-PAPVC)

Between January 1981 and December 1983, 4 patients, aged 6 to 50 years, with It-PAPVC were operated upon at the Kokura Memorial Hospital, by a new technique of anastomosis between the left anomalous PV and the left auricular appendage. One patient, a 9-year-old male, had unilateral anomalous pulmonary venous connection of the entire left lung to the innominate vein. The other three patients had partial anomalous pulmonary venous connection from the left upper lobe to the innominate vein. Two patients has pulmonary valvular stenosis, and the other two had ASD. All patients were operated upon through a midsternal incision. After cardiopulmonary bypass was established, the anomalous vein was divided as high as was reachable. The present operative method involved the use of an oval pericardial gusset extending from the left auricular appendage into the split anomalous vein so as to obtain a wide anastomotic orifice. Other associated congenital anomalies were simultaneously corrected. All patients had uneventful recovery and at postoperative cardiac catheterization and angiography, the anastomosis between the pulmonary vein and the left auricular appendage was widely patent.     

A case of ligating both upper and anomalous lower left pulmonary veins in the left upper lobectomy

A 53-year-old male was anesthetized for left upper lobectomy under one-lung ventilation using a double-lumen endobronchial tube in the lateral position. When the upper left pulmonary vein was ligated, Pao2/FIo2 ratio (PF ratio) was elevated despite the one-lung ventilation. After the operation, the patient was repositioned onto spine position and massive bleeding occurred from the anomalous lower left pulmonary vein, which was ligated during the operation. The lower left pulmonary vein was restored and the bleeding stopped. Because the pulmonary shunt flow from the lower left pulmonary vein had stopped, the PF ratio was unusually elevated. We urge anesthesiologists to pay attention to the arterial blood gas data even when it is better than expected.