Successful Treatment of a Case of Partial Anomalous Pulmonary Venous Connection (PAPVC) with Interventional Transcatheter Closure

Abstract

BackgroundPartially anomalous pulmonary venous connection (PAPVC) is a rare type of congenital cardiovascular disease in which part of the pulmonary veins connects to the right atrium or its tributaries. Traditionally, when patients have evidence of blood drainage pathway, multiple malformations, and/or significant left‐to‐right shunt, treatment has always required a hypothermia by‐pass thoracotomy under general anesthesia. Invasive surgical treatment of these conditions in the elderly patients leads to high risk for complications and slow recovery. The authors report the successful treatment of a PAPVC patient with interventional transcatheter to eliminate the left‐to‐right shunt, decrease overloads of right heart and further avoid the sinoatrial node dysfunction by surgery.MethodsA 55‐year‐old female patient was admitted due to a complaint of intermittent chest tightness, chest pain, shortness of breath, one year of radiating pain to the right back and deterioration in the two months prior. Computed tomography angiography (CTA) revealed upper left pulmonary vein drainage into left brachiocephalic vein and dilation of right heart; therefore, a PAPVC was suspected. Ultrasound indicated decrease of left ventricular diastole function ( III) moderate mitral regurgitation, with no evidence of an intracardiac shunt. Digital subtraction angiography (DSA) revealed a contrast drainage from left upper pulmonary vein into left subclavian vein via an ascending vertical vein, and some contrast flowed into left ventricle. Amplatzer device of 16mm was deployed via a long 10 French sheath and precisely released into the bifurcation of the left brachiocephalic vein and vertical vein to block the persisting vertical vein. Contrast injected into left subclavian vein showed successful occlusion of vertical vein. Contrast drain into right atrium through left brachiocephalic vein and superior vena cava.ResultsThe PAPVC patient was found with the upper left pulmonary vein drainage into left subclavian vein via an ascending vertical vein, the pulmonary vein drainage into left atrium and a partial left‐to‐right shunt. After carefully reviewed the results of examination, the vertical vein was occluded with interventional transcatheter. There was no arrhythmia, intraoperative and postoperative complaints. The symptoms of chest tightness and chest pain were resolved completely. Patient was discharged from the hospital three days after surgery. Ultrasound examination two weeks later showed normal diastolic function of left ventricle, no mitral regurgitation, and no vertical vein shunt. Patient had no complaints during postoperative check at 2 months. Follow up ultrasound at 3 months after surgery showed no evidence of pulmonary artery hypertension.ConclusionsFor the elderly and PAPVC with many complications, minimally invasive surgery such as catheter intervention is an alternative approach. A case of PAPVC patient was successfully treatment with an Amplatzer ductal occlusion device to obstruct the vertical vein between the pulmonary circulation and systemic circulation instead of using a thoracotomy surgery. This device appears to be an appropriate choice of intervention in such unusual cases requiring venous occlusion.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.