Partial Anomalous Pulmonary Venous Return With Persistent Angina: Simulating Coronary Artery Disease

Abstract

Partial anomalous pulmonary venous return (PAPVR) is an uncommon adult congenital heart disease caused by an abnormal return of one or more, but not all, of the pulmonary veins to the right atrium or indirectly through venous connections from the anomalous pulmonary vein. Presentations vary from incidental findings to severe heart failure and diagnosis could easily be missed. We report a case of PAPVR in a 51-year-old male with a history of coronary artery bypass surgery presenting with exertional dyspnea and chest discomfort which were initially interpreted as angina in light of patient’s known coronary disease and prior revascularization. Patient underwent surgical repair with redirection of the pulmonary connection to the left atrium. On follow-up, patient had symptomatic improvement and decrease in pulmonary artery pressures. Diagnosis of PAPVR may be particularly elusive when patient also has a more common diagnosis, such as coronary disease. Unexplained pulmonary hypertension should alert physicians to consider additional differential diagnoses including congenital heart disease despite the patient’s adult age. As evidenced in this patient, successful surgical repair can lead to gratifying results and improved prognosis.