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An unusual cause of pulmonary hypertension; partial anomalous pulmonary venous return to coronary sinus detected on transesophageal echocardiography.

ABSTRACT:

SUBMITTER: Erdogan E

PROVIDER: S-EPMC6683225 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Warden repair for superior sinus venosus atrial septal defect and anomalous pulmonary venous drainage in children: Anesthesia and transesophageal echocardiography perspectives.

Project description:ObjectiveReview of intraoperative anesthetic challenges and the role of transesophageal echocardiography in children with sinus venosus atrial septal defect and partial anomalous pulmonary venous drainage undergoing Warden repair.DesignA retrospective observational case series. METHODOLGY: Pediatric patients who underwent Warden repair between October 2011-September 2015 were recruited. Their preoperative clinical details, anesthetic techniques, intraoperative TEE findings and postoperative events were recorded from the medical records. The categorical variables and the continuous variables were expressed as number (percentages) and mean ? SD respectively.ResultsA total of 35 patients were operated for Warden repair during the study period. Anesthesia was induced with the aim to prevent any fall in pulmonary vascular resistance. The right internal jugular vein was cannulated under ultrasound guidance using a short length cannula to monitor right superior vena cava pressure. Intraoperative TEE revealed the drainage of PAPVC high into RSVC in 22 patients. Persistent LSVC was found in 9 patients. After repair, TEE imaging detected a high gradient at Warden anastomotic site in 5 patients and 3 of them required revision of surgery. Rerouted pulmonary veins required surgical correction in 2 patients in view of obstruction. None of them had pulmonary venous and SVC obstruction in the postoperative period.ConclusionThe primary aim of anesthesia is to avoid any fall in PVR. Right IJV cannulation can be beneficial. The intraoperative TEE can help in delineating the anatomy of lesion and detecting anastomotic site obstruction.

| S-EPMC4900353 | biostudies-literature

Partial anomalous pulmonary venous return: A case series with management approach.

Project description:Partial anomalous pulmonary venous return (PAPVR) is a rare congenital anomaly that results in a left-to-right shunt. Based on the shunt fraction, PAPVR has a wide spectrum of presentations. If a significant left-to-right shunt is left unrepaired, pulmonary vascular remodeling can occur resulting in the development of pulmonary arterial hypertension (PAH). Furthermore, if the condition is associated with an atrial septal defect (ASD), the patient can develop shunt reversal and Eisenmenger's syndrome in setting of severe PAH. Management plans include close observation, surgical repair, and treatment with pulmonary artery vasodilator therapies. Here, we present multiple cases of PAPVR to highlight the wide spectrum of presentations and the individualized treatment for each case.

| S-EPMC6456451 | biostudies-literature

Unrecognized Patent Foramen Ovale in Patient With Sinus Venosus-Type Atrial Septal Defect With Partial Anomalous Pulmonary Venous Return.

Project description: Not available

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Case Report: Double-Decker Repair of Partial Pulmonary Venous Return Into the Coronary Sinus.

Project description:We present a case of persistent left superior vena cava (LSVC) draining into the right atrium (RA) via the coronary sinus (CS), while the left superior pulmonary vein returns abnormally to the CS. The LSVC may have few clinical consequences but complicates surgical repair of partial anomalous pulmonary venous return (PAPVR). Transthoracic echocardiography and computed tomographic angiography (CTA) showed that a persistent LSVC and PAPVR converged behind the left atrium. During the operation, the left atrium was adjacent to the confluence part. We resected a portion of the adjacent left atrium to create an inlet of the pulmonary veins and used two autologous pericardial patches to reconstruct a tunnel directing flow from the left pulmonary veins to the surgically created inlet in the adjacent left atrium, and another upper tunnel directing flow from the LSVC to the dilated CS. Pulmonary CTA confirmed that both PAPVR flow to LA and LSVC flow to RA were unobstructed. At a 12-month follow-up, the patient was asymptomatic. No supraventricular arrhythmia was detected. We would like to present this additional technique to our armamentarium to treat PAPVR in combination with LSVC.

| S-EPMC9016128 | biostudies-literature

Three-Dimensional-Enabled Surgical Planning for the Correction of Right Partial Anomalous Pulmonary Venous Return.

Project description:ObjectivesThe surgical technique for right partial anomalous pulmonary venous return (PAPVR) depends on the location of the anomalous pulmonary veins (PVs). With this in mind, we sought to evaluate the impact of 3D heart segmentation and reconstruction on preoperative surgical planning.MethodsA retrospective study was conducted on all patients who underwent PAPVR repair at our institution between January 2018 and October 2021; three-dimensional segmentations and reconstructions of all the heart anatomies were performed. A score (the PAPVR score) was established and calculated using two anatomical parameters (the distance between the most cranial anomalous PV and the superior rim of the sinus venosus defect/the sum of the latter and the distance between the PV and the azygos vein) to predict the type of correction.ResultsA total of 30 patients were included in the study. The PAPVR score was found to be a good predictor of the type of surgery performed. A value < 0.68 was significantly associated with a Warden procedure (p < 0.001) versus single/double patch repair.ConclusionsThree-dimensional heart segmentations and reconstructions improve the quality of surgical planning in the case of PAPVR and allow for the introduction of a score that may facilitate surgical decisions on the type of repair required.

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Total Anomalous Pulmonary Venous Return with No Connection.

Project description: Not available

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Robotic-assisted two-patch repair of right partial anomalous pulmonary venous connection and sinus venosus defect.

Project description: Not available

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Partial detachment of tricuspid valve annuloplasty ring detected by three-dimensional transesophageal echocardiography.

Project description: Not available

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Pulmonary venous baffle obstruction following senning procedure - Role of transesophageal echocardiography.

Project description:We present a case of D-transposition of great arteries with atrial septal defect and patent ductus arteriosus electively posted for Senning's operation at 10 months of age. The patient developed signs of lung congestion immediately after termination of cardiopulmonary bypass. A stenosis in the pulmonary venous baffle was detected in transesophageal echocardiography showing a peak gradient of 10 mmHg and a mean gradient of 5 mmHg. Hence, revision of baffle was planned. The stenotic area was excised and augmented with homologous pericardium. Post-correction, lung compliance improved and the peak and mean gradient decreased to 3 and 1 mm Hg, respectively. The patient was extubated in the intensive care unit after 36 h and shifted to ward after 5 days with stable hemodynamics.

| S-EPMC7336969 | biostudies-literature

Transesophageal echocardiography for coronary sinus imaging in partially unroofed coronary sinus.

Project description:BackgroundPartially unroofed coronary sinus (PUCS) is a rare congenital cardiac anomaly and prone to be misdiagnosed. The purpose of this study was to explore the value of transesophageal echocardiography (TEE) in CS imaging for the detection of PUCS and to develop a special two-dimensional TEE-based en face view of CS.MethodsTwenty adult patients with suspected PUCS, showing a dilated coronary sinus and an enlarged right heart on transthoracic echocardiography (TTE), underwent TEE examination. In the mid-esophageal plane and close to an angle of 120°, the en face view of the CS successfully imaged the roof of the CS, which was beyond the realm of the atrial septum, and the interatrial septum was obtained simultaneously in the same view. Meanwhile, the 3D zoom mode could clearly display the comprehensive volume image and the adjacent structures of the PUCS. The results of TEE were compared with the findings of surgery or catheterization.ResultsEn face view of the CS was obtained successfully by 2DTEE in 20 patients. In addition, 3DTEE was used for imaging of PUCS in 11 of the 20 patients. PUCS was ultimately confirmed in 13 patients either by surgery or catheterization. The TEE for PUCS diagnosis was consistent with the surgical findings.ConclusionTransesophageal echocardiography can be successfully applied to obtain the comprehensive view of CS and its surrounding structures. The en face view of CS provided by 2DTEE may be helpful in better understanding PUCS and discriminating it from associated atrial septal defects.

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