A Review on the Spectrum of Partial Anomalous Pulmonary Venous Connections: The Added Value of Computed Tomography Imaging

Abstract

Introduction: Partial anomalous pulmonary venous connection (PAPVC) is a rare congenital cardiovascular condition in which one or some of the pulmonary veins (PV) but not all drain into systemic circulation rather than into the left atrium (LA). Accurate detection of these anomalies is important because of its association with patient morbidity and mortality. Although the PV anatomy can be evaluated by Echocardiography or angiography, noninvasive modalities like multidetector computed tomography (MDCT), magnetic resonance imaging (MRI) now play crucial role in the characterization of pulmonary veins. Aim: The aim of this article is to review various patterns PAPVC diagnosed, the associated cardiac defects, the role of various imaging modalities and their implications in the management and also to review the embryology of the PV. Materials & Methods: A retrospective study was conducted in 21 consecutive patients with PAPVC. The various patterns of PAPVC and associated cardiac defects was studied using echocardiography, cardiac catheterization and MDCT. Results: There were 13 males and 8 females and their age at diagnosis ranged from day 1 to 50 years. Most common type was right sided PAPVC in 15 patients, Left sided PAPVC in 3 patients. Mixed type where PAPVC of both right and left sided veins occur in 3 patients. Accessory pulmonary veins were identified in 4 patients. Most common associated cardiac defect was secundum ASD (OS ASD). Conclusions: PAPVC cannot be classified into stereotypic types as there is wide spectrum of developmental anomalies exist. A single diagnostic modality may not detect every anomaly. Even though echocardiography is the initial imaging technique of choice it is suboptimal and MDCT now provides very rapid and accurate imaging.