J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 2 8 e3 2 9

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Images in Cardiovascular CT

Dual connection of single pulmonary vein in partial anomalous pulmonary venous return Christopher Vihlen MDa,*, Kurt Scherer MDb, Eric Thoburn MDc, Arun Chandran MDd a

Department of Radiology (PGY-4), University of Florida, 1600 SW Archer Rd, Gainesville, FL 32608, USA Department of Radiology (PGY-5), University of Florida, Gainesville, FL, USA c Division of Cardiac Imaging, Department of Radiology, University of Florida, Gainesville, FL, USA d University of Florida Congenital Heart Center, Department of Pediatric Cardiology, University of Florida, Gainesville, FL, USA b

article info

abstract

Article history:

We present the case of a 6-month-old infant born premature at 29 weeks with perinatal

Received 13 May 2013

stroke and postnatal hypoxia. Echocardiogram was suspicious for partial anomalous pul-

Received in revised form

monary venous return (PAPVR). Cardiac CT showed an unusual variant of PAPVR, with a

9 July 2013

vertical vein having a dual connection superiorly to the left innominate vein and inferiorly

Accepted 16 August 2013

to the morphologic left atrium. This unusual variant has the potential for right-to-left flow with a possibility of systemic hypoxia and paradoxical embolism.

Keyword:

ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved.

Partial anomalous pulmonary venous return (PAPVR)

A 6-month-old premature infant presented with perinatal stroke and hypoxia. Echocardiogram (Video 0) was suspicious for partial anomalous pulmonary venous return (PAPVR). A prospectively gated pediatric cardiac CT (80 kVp, 210 mA, 0.47s rotation time; 2 mL/kg Visipaque 320) confirmed PAPVR. The left upper lobe pulmonary vein drained to a vertical vein that had 2 connections: a superior connection to the left innominate vein (Fig. 1) and an inferior connection to the morphologic left atrium (Figs. 2 and 3; Videos 1e3). The patient underwent cardiac catheterization with occlusion of the accessory left vertical vein with an Amplatz vascular plug (Videos 4e6).

PAPVR is present in approximately 0.5% of the population, involving alternative drainage of anomalous veins to systemic sites. The most common site of supracardiac drainage is into the superior vena cava, if on the right, and if on the left drainage is into the left innominate vein, a persistent left superior vena cava, or the coronary sinus.1 Many (47%) involve the left upper lobe and 38% involve the right upper lobe pulmonary venous drainge.2 This case was unique because, in addition to the typical connection of the anomalous pulmonary vein to the left innominate vein, the same single vertical vein had a persistent connection to the left atrium, having the

Conflict of interest: The authors report no conflict of interest. * Corresponding author. E-mail address: [email protected] (C. Vihlen). 1934-5925/$ e see front matter ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2013.08.013

J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 2 8 e3 2 9

Fig. 1 e Anteroposterior projection of cardiac CT examination with intravenous contrast shows the cranial end of the left vertical vein entering the left innominate vein (arrow).

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Fig. 3 e Anteroposterior projection of cardiac CT examination with intravenous contrast shows the cardiac end of the left vertical vein entering the morphologic left atrium (arrow).

potential for right-to-left flow with possible systemic hypoxia and paradoxical embolism.

Acknowledgments Special acknowledgement to James Fudge, MD (Assistant Professor, UF Congenital Heart Center, Department of Pediatric Cardiology, University of Florida) for performing the Amplatz plug placement and for contributing the procedural images.

Supplementary material Supplementary data related to this article can be found at http://dx.doi.org/10.1016/j.jcct.2013.08.013.

references

Fig. 2 e Three-dimensional volume surface rendering image shows a dual connection of the left vertical vein to the left innominate vein and the left atrium (arrow).

1. Webb R, Higgins C. Thoracic Imaging Pulmonary and Cardiovascular Radiology. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2011. 2. Ho ML, Bhalla S, Bierhals A, Gutierrez F. MDCT of partial anomalous pulmonary venous return (PAPVR) in adults. J Thorac Imaging. 2009;24:89e95.

Dual connection of single pulmonary vein in partial anomalous pulmonary venous return.

We present the case of a 6-month-old infant born premature at 29 weeks with perinatal stroke and postnatal hypoxia. Echocardiogram was suspicious for ...
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