Neglected Partial Anomalous Pulmonary Venous Return during Atrial Septal Defect Device Closure

Elahe Radmehr; Hassan Radmehr; Mohsen Shahidi; Keyhan  Sayadpour Zanjani

doi:10.18502/jthc.v18i3.14119

Elahe Radmehr Colorectal Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Hassan Radmehr Department of Pediatric Cardiac Surgery, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Mohsen Shahidi Department of Pediatrics, Besat Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran.
Keyhan Sayadpour Zanjani Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jthc.v18i3.14119

Keywords: Pulmonary veins; Heart septal defects, atrial; Septal occluder device; Cardiac surgical procedures; Child

Abstract

Partial anomalous pulmonary venous return (PAPVR) is a rare congenital heart malformation in which 1 or more pulmonary veins drain into the systemic venous circulation or directly into the right atrium instead of the left atrium. It may occur alongside other congenital heart defects, including atrial septal defect (ASD). All patients with newly diagnosed ASD must be evaluated thoroughly for the likelihood of PAPVR to select surgical or percutaneous procedures.

Here, we describe a 10-year-old girl with PAPVR who underwent percutaneous device closure of her secundum ASD with her PAPVR neglected at 3 years of age. We had to correct the anomalous venous connection by removing the device during an intricate procedure. The typical connection of the pulmonary veins to the left atrium was reported on her postoperative echocardiography 1 day after surgery. The patient was discharged without complications, and her first follow-up visit 7 days after discharge was unremarkable. While the most accurate diagnostic tools for PAPVR are cardiovascular magnetic resonance imaging and computed tomographic angiography, a careful examination of the pulmonary veins during pulmonary angiography or transesophageal echocardiography in children helps identify PAPVR in patients with ASD.