Abstract
Transcatheter interventions for congenital heart anomalies are constantly improving. Although correction of anomalous pulmonary venous connection is routinely achieved through surgery, there are rare instances where the abnormal pulmonary vein has dual connections to both left atrium and the major systemic veins. Under these circumstances catheter based treatment might become a feasible option. We report a case of dual supply vertical vein connected to left upper pulmonary vein and innominate vein which was successfully obstructed by an occluder device leading to improvements in patient’s condition.
Highlights
Partial anomalous pulmonary venous connections (PAPVCs) are abnormal connections of the one or more of the pulmonary veins to the right sided heart chambers leading to left to right shunting of blood
The patient underwent cardiac catheterization that confirmed the connection of the vertical vein to both innominate vein and the left atrium via the left upper pulmonary vein (Figures 3 and 4)
Left sided PAPVCs generally connect to right side chambers via a vertical vein with flow towards innominate vein, SVC and RA [1]
Summary
Partial anomalous pulmonary venous connections (PAPVCs) are abnormal connections of the one or more of the pulmonary veins to the right sided heart chambers leading to left to right shunting of blood. The abnormal pulmonary vein (PV) has a dual connection to both left atrium (LA) and the superior/ inferior vena cava via a Simitar or vertical vein. The patient underwent cardiac catheterization that confirmed the connection of the vertical vein to both innominate vein and the left atrium via the left upper pulmonary vein (Figures 3 and 4). After confirming the appropriate position, the device was released at the end of the vertical vein. Follow up echocardiography 24 hours after the procedure showed eliminated flow of the vertical vein and proper position of the device with no compressive effect on adjacent structures and no clot. Transthoracic echocardiography one, six and twelve months post- procedure confirmed satisfactory results with reduction in right ventricle end diastolic diameter and good device position. We decided to administer dual antiplatelet therapy to our patient for a period of three to six months similar to transcatheter ASD/VSD closure procedures
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