Vein Drainage Research Articles

The Incidence of the Agenesis of Fetal Ductus Venosus at the 11-13 Weeks' Ultrasound Examination.

The objective is to examine the incidence of agenesis offetal ductus venosus (DV) at the routine ultrasound examination at 11-13 weeks. This is a retrospective study on women presenting for screening for chromosomal abnormalities. The fetal DV was routinely examined by color Doppler in the sagittal view. Out of 8,304 fetuses examined, there were 13 cases of DV agenesis (0.15%). The umbilical vein drainage was intra-hepatic in two-thirds of the cases, and all resulted in normal live births. In the remaining one-third of cases, the umbilical vein drained to the inferior vena cava and all had a poor outcome because of aneuploidies, cardiac defects, and Noonan syndrome. Fetal DV agenesis occurs in about one in 650 fetuses and the majority of cases have a benign course and a favorable outcome. Failure to identify the DV should prompt a detailed ultrasound examination, identification of the drainage site of the umbilical vein, and genetic testing.

Percutaneous recanalization in hepatic vein-type Budd-Chiari syndrome: hepatic or accessory hepatic vein

Purpose This study was designed to assess the clinical efficiency and long-term outcomes of hepatic vein (HV) and accessory hepatic vein (AHV) recanalization in patients with HV-type Budd-Chiari syndrome (BCS). Material and methods A total of 27 patients with HV-type BCS underwent AHV recanalization and 94 patients had HV recanalization at our center from January 2012 to December 2019. The treatment effectiveness and long-term outcomes were compared. Results Technical success was accomplished in all patients, without any procedure-related complications. The clinical success rates were 96.3% (26/27) and 95.7% (90/94) (p = 1.000). In the AHV and HV groups, re-obstruction was observed in 5 and 36 patients, respectively (p = 0.056). The median primary durations of AHV and HV patency were 64 and 49 months, respectively (p = 0.036), while the median secondary durations of AHV and HV patency were 70 and 64 months, respectively (p = 0.134). The median overall survival after AHV and HV recanalization was 73 and 78 months, respectively (p = 0.263). Conclusions Our findings suggest that AHV could be employed as a replacement for HV, as a hepatic drainage vein, in HV-type BCS patients.

Appearance of medullary and cortical veins on multiphase CT-angiography in patients with acute ischemic stroke

ObjectiveWe sought to determine if interhemispheric asymmetry of cortical and medullary veins evaluated on CT angiography can provide a more accurate prediction of outcome in patients with acute ischemic stroke when compared to hemispheric asymmetry of cortical or medullary vein drainage alone. MethodsWe retrospectively reviewed a database of patients with anterior circulation distribution acute ischemic stroke, who were evaluated by multiphase CTA. Cortical veins were evaluated using the adopted Prognostic Evaluation based on Cortical vein score difference In Stroke (PRECISE) system. Medullary veins were evaluated by the presence of asymmetry determined by 5 or more medullary veins visualized in one hemisphere as compared to the contralateral. Good clinical outcome was defined as a Modified Rankin Scale of 0–2 at 90 days. Results64 patients were included. The adopted PRECISE score was associated with a good clinical outcome in patients with AIS (OR=3.29; 95 % CI: 1.16 – 9.30; p = 0.023) and had a stronger association with clinical outcome (AUC=0.644) as compared to the asymmetry of MV (AUC=0.609). In a multivariable logistic regression model, combined medullary and cortical vein asymmetry were independently associated with clinical outcomes (AUC=0.721). ConclusionCombined cortical and medullary vein interhemispheric asymmetry is a stronger predictor of clinical outcome in acute ischemic stroke compared to cortical or medullary vein asymmetry alone.

Development and validation of a model for predicting the risk of brain arteriovenous malformation rupture based on three-dimensional morphological features.

Brain arteriovenous malformation (bAVM) is an important reason for intracranial hemorrhage. This study aimed at developing and validating a model for predicting bAVMs rupture by using three-dimensional (3D) morphological features extracted from Computed Tomography (CT) angiography. The prediction model was developed in a cohort consisting of 412 patients with bAVM between January 2010 and December 2020. All cases were partitioned into training and testing sets in the ratio of 7:3. Features were extracted from the 3D model built on CT angiography. Logistic regression was used to develop the model, with features selected using L1 Regularization, presented with a nomogram, and assessed with calibration curve, receiver operating characteristic (ROC) curve and decision curve analyze (DCA). Significant variations in associated aneurysm, deep located, number of draining veins, type of venous drainage, deep drainage, drainage vein entrance diameter (Dv), type of feeding arteries, middle cerebral artery feeding, volume, Feret diameter, surface area, roundness, elongation, mean density (HU), and median density (HU) were found by univariate analysis (p < 0.05). The prediction model consisted of associated aneurysm, deep located, number of draining veins, deep drainage, Dv, volume, Feret diameter, surface area, mean density, and median density. The model showed good discrimination, with a C-index of 0.873 (95% CI, 0.791-0.931) in the training set and 0.754 (95% CI, 0.710-0.795) in the testing set. This study presented 3D morphological features could be conveniently used to predict hemorrhage from unruptured bAVMs.

Management of high-output cardiac failure caused by head and neck AVMs: Percutaneous suture-assisted ethanol and coil embolotherapy.

The aim of this study was to describe the treatment technique, outcomes, and complications of Schobinger stage IV head and neck arteriovenous malformations (HNAVMs) with associated high-output cardiac failure (HOCF) using ethanol and coils with the percutaneous suture technique. From January 2015 to December 2019, 19 patients who had HNAVMs with associated HOCF were treated first with a percutaneous suture of the remarkably dilated dominant drainage vein (RDDOV) and subsequent embolization with coils and ethanol. The percutaneous suture of RDDOV was preferred to be performed, followed by the deployment of coils and the injection of absolute ethanol via transarterial approach, direct puncture approach, or both of them. Treatment outcomes and complication rates were evaluated at follow-up. A total of 19 patients who experienced HNAVMs with HOCF received 19 percutaneous suture procedures and 84 embolization procedures with ethanol and coils. Complete or >90% shunt reduction of the AVM was achieved in 16 patients. Notably, 19 patients with New York Heart Association (NYHA) stage II improved to stage I, and the symptom of dyspnea disappeared after embolization. The symptoms of five patients with bleeding disappeared. All patients presented with cosmetic concerns; Four were cured, and eight had a clearly recognizable improvement. Of note, 19 (100%) patients presented with impairment of daily life, which was resolved. The minor complications were encountered and recovered by the self. No major complications occurred. This study provides evidence that ethanol and coil embolotherapy is effective and safe in treating HOCF caused by HNAVMs with acceptable complications in these cases. The percutaneous suture technique for RDDOV management can act as an adjunct for embolotherapy.

En face Ultrawidefield OCT of the Vortex Vein System in Central Serous Chorioretinopathy

To investigate whether noninvasive en face ultrawidefield (UWF) OCT can demonstrate salient features of the choroidal vasculature in eyes with central serous chorioretinopathy (CSC). Retrospective observational case series. Patients diagnosed with CSC who underwent UWF indocyanine green angiography (ICGA) and widefield OCT imaging were included. Widefield OCT imaging was performed with a horizontal 23-mm× vertical 20-mm field of view of 5 visual fixations (1 central and 4 peripheral fixations) to compose structural en face UWF OCT montage images and UWF choroidal thickness maps. Automated image alignment was performed before grading. A comparison of choroidal vascular findings seen with UWF ICGA and en face UWF OCT images, including size and distribution of choroidal venous drainage areas and identification of dilated choroidal veins (pachyvessels) crossing the physiologic choroidal watershed zones. The spatial correlation between choroidal vascular hyperpermeability on UWF ICGA images and areas of choroidal thickening on UWF choroidal thickness maps was determined. Forty-two eyes from 27 patients with CSC with a mean age of 56 ± 12 years (range, 31-77 years) were included. Quantitative measures of vortex vein drainage areas on en face UWF OCT images were significantly and positively correlated with those obtained with UWF ICGA (mean Pearson r= 0.825, P < 0.01). Identification of pachyvessels crossing the choroidal watershed zones showed an excellent correlation between UWF ICGA and en face UWF OCT images (mean Spearman ρ= 0.873, P < 0.01). In all cases, choroidal vascular hyperpermeability was observed on UWF ICGA spatially colocalized with areas of choroidal thickening on the UWF choroidal thickness map. Congestion within the entire drainage area of the dominant vortex systems was observed on UWF choroidal thickness maps. In eyes with CSC, noninvasive en face UWF OCT imaging can show distinctive features of choroidal venous insufficiency previously identified with UWF ICGA. Ultrawidefield OCT choroidal thickness maps enable quantitative assessment of choroidal congestion. Proprietary or commercial disclosure may be found after the references.

CLINICAL CASE OF BIPLASTIC CORRECTION OF ABNORMAL PULMONARY VEIN DRAINAGE WITH SINUS VENOSUS DEFECT IN A DOMINANT INNOMINATE VEIN IN ADOLESCENCE

Sinus venosus defectis an unusual type of interatrial communication and is almost always combined with partial abnormal pulmonary vein drainage (PAPVD) into the superior venacava (SVC) or right atrium (RA). Different types of venous outflow through the vena cava occur: the presence of an additional left vena cava with different drainage loci to both right and left atriaor, as in our case, the dominant unpaired vein directly draining into the right atrium with outprior communication with the superior right vena cava. This paper describes a clinical case of radical correction of partial anomalous pulmonary vein drainage combined with sinus venosus atrial septal defect (ASD) in a 14-year-old child with dominant venous outflow from the upper half of the body via innominate vein, by combined biplasty from auto pericardial patches, showing adequate upper-venous outflow under cardiopulmonary bypass. It is necessary to provide clear information about congenital heart disease and optimal timing of its surgical correction to a wide audience, not only to the professional medical community, but importantly, to the entire population of the Republic. The provision of publicly available professional information should be highlighted on the official websites of clinics and all available media opportunities, where parents and patients could be fully acquainted with the specific soft entire treatment processing an accessible and convenient information platform.

Anomalous drainage of the right gonadal vein.

The present research aims to present and describe an unusual and rare anatomical variation in relation to the drainage of the right gonadal vein. This anatomical knowledge is crucial as it assists in the work of surgeons and health professionals in general. The dissection occurred in the anterior wall of the abdomen and, through observational analysis, an anatomical variation was found in the drainage of the right gonadal vein in a human cadaver, obtained by anonymous donation, male gender and without predetermined clinical characteristics, ethnicity, and age, belonging to the Padre Albino University Center collection. This research was approved by the Research Ethics Committee under protocol 12923919.8.0000.5430. The drainage of right gonadal vein is this variant occurs anastomosed with an innominate venous trunk that empties into the inferior vena cava. Furthermore, the presence of an accessory right renal vein is also noticed, which anastomoses with the innominate venous trunk and with the right renal vein, through a vein suggestively called interrenal, differing from the anatomical normality described in the literature. This variation is supposed to occur due to flaws in the development of the embryo, which generate venous changes in the origins of the right gonadal vein. Acknowledging the existence of it is relevant when performing surgical procedures in the region, as it differs from the most frequent anatomy found in the human population. The rare drainage of the right gonadal vein through an innominate trunk to the inferior vena cava and its importance is highlighted in this article.

A unique presentation of anomalous posterior intercostal veins, hemiazygos vein and left superior vena cava

The venous anomalies of thorax are common, but the only drainage of 1st and 2nd posterior intercostal veins on both sides into the internal vertebral venous plexus with no communication to the azygos system is reported for the first time. The common hemiazygos vein is singular receiving all the posterior intercostal veins on the left from 4th to the 11th with subcostal on the left side. This vein drains into azygos on the right. It also connects on the cranial end via an anomalous vein to the Left SVC. This anomalous vein also receives the left 3rd posterior intercostal vein. On the right, the azygos system is normal.

Infra-cardiac TAPVC with an intrahepatic portosystemic shunt: A rare association.

Total anomalous pulmonary venous connection (TAPVC) is an uncommonly encountered cyanotic congenital heart disease characterized by anomalous drainage of the pulmonary veins. Concomitant venous anomalies are rarely found in these patients. We present a case of an infra-cardiac TAPVC with an intrahepatic portosystemic shunt, where a vascular channel was seen between the middle hepatic vein and the left branch of the portal vein with fusiform dilatation of the latter, diagnosed on computed tomography angiography.

Misplaced drainage tube inserted in the vein in a percutaneous nephrostomy: a case series.

Percutaneous nephrostomy is a critical procedure for establishing surgical pathways from the skin to the renal collecting system. The drainage tube involved in the procedure rarely deviates into the renal vein. Herein, we report three cases in which the related drainage tube was mistakenly inserted into the renal vein and inferior vena cava after the renal vein was injured during percutaneous nephrostomy. In the three cases, the nephrostomy tube and double-J tube were gradually withdrawn from the renal pelvis or renal calyces under computed tomography (CT) monitoring. In case 1, the fistula tube was not completely withdrawn in time into the renal, causing multiple thromboses in the vein. The fistula was successfully withdrawn from the vena cava after the filter was placed. Finally, the stones were cleared in two cases and one case was discharged without complications after substantial renal function recovery. A safe and reliable approach is to gradually withdraw, within a short timeframe and under CT monitoring, an ectopic renal vein or inferior vena cava drainage tube into the renal pelvis. Removal of the catheter to the renal pelvis or calyces within 3 days can reduce thrombotic complications.

Predictive Efficacy of Circulating Tumor Cells in First Drainage Vein Blood from Patients with Colorectal Cancer Liver Metastasis

Circulating tumor cells (CTCs) are associated with metastasis. However, the low rate of detection of CTCs in peripheral vein blood (PVB) limits their clinical application. In this study, we observed higher positive rates of CTC in first drainage vein blood (FDVB) relative to peripheral venous blood (p < 0.001). Moreover, the CTC content was related to liver metastasis, T stage, and CA19-9 levels. Our collective data suggest that CTCs in FDVB have good predictive utility for the risk of liver metastasis of colorectal cancer (CRC), in particular, metachronous liver metastasis.

Prophylactic Awake Peripheral VA ECMO TAVI Is Safe and Effective: A Case Series and Patient Management Algorithm

Sylvian arteriovenous malformations (sAVMs) are rare and account for approximately 8%–11% of all intracranial arteriovenous malformations (AVMs).1 Because of their proximity to eloquent structures such as the motor speech center, insular cortex, and internal capsule, microsurgical resection of sAVMs remains a challenge.Several classifications have already been suggested for sAVMs, such as Sugita and Yasargil.1,2 It is well established that for low-grade AVMs, results of the microsurgical resection are excellent and tend to favor surgery,1, 2, 3 but in high-grade AVM, a multimodal assessment is necessary for formulating treatment strategies.1In Video 1, we demonstrate the surgical resection of a ruptured sylvian temporal AVM. This AVM was localized in the superior surface of the temporal lobe, and its nidus was just beneath the cortical surface of this lobe. Because it was 5.1 cm at its largest diameter, had a deep drainage vein, and was localized adjacent to the Wernicke area, we classified it as a Spetzler-Martin grade IV AVM.4Despite the high-grade AVM, microsurgical treatment was the choice in this ruptured AVM and there was no increase in morbidity.

Topical Drug Application to Treat Infective Endocarditis – Preclinical Investigation of Novel Therapeutic Options for an Unmet Medical Need

Sylvian arteriovenous malformations (sAVMs) are rare and account for approximately 8%–11% of all intracranial arteriovenous malformations (AVMs).1 Because of their proximity to eloquent structures such as the motor speech center, insular cortex, and internal capsule, microsurgical resection of sAVMs remains a challenge.Several classifications have already been suggested for sAVMs, such as Sugita and Yasargil.1,2 It is well established that for low-grade AVMs, results of the microsurgical resection are excellent and tend to favor surgery,1, 2, 3 but in high-grade AVM, a multimodal assessment is necessary for formulating treatment strategies.1In Video 1, we demonstrate the surgical resection of a ruptured sylvian temporal AVM. This AVM was localized in the superior surface of the temporal lobe, and its nidus was just beneath the cortical surface of this lobe. Because it was 5.1 cm at its largest diameter, had a deep drainage vein, and was localized adjacent to the Wernicke area, we classified it as a Spetzler-Martin grade IV AVM.4Despite the high-grade AVM, microsurgical treatment was the choice in this ruptured AVM and there was no increase in morbidity.

First experience of staged treatment of an infant with heterotaxy syndrome with total anomalous pulmonary vein drainage combined with a single ventricular heart and pulmonary atresia

The combination of monoventricular congenital heart disease with total anomalous pulmonary vein drainage and pulmonary atresia, is a rare pathology and characterized by an extremely severe course with the highest mortality. In the presented work we described a clinical case of the first and successful experience of two-stage treatment of an infant with total anomalous pulmonary vein drainage combined with single ventricular heart disease and pulmonary atresia in the Republic of Kazakhstan. For total anomalous pulmonary vein drainage correction we used a sutureless technique — primary sutureless repair, which is used in our center as a primary one. Due to severe anatomy of the defect, we used unusual area of the distal end of the central systemic-pulmonary artery anastomoses during primary surgery at the mouth of the severed patent ductus arteriosus in the area of pulmonary artery bifurcation, where it is associated with high surgical risks. Taking into account the presence of an additional obstacle to pulmonary blood flow in the form of left branch pulmonary artery orifice stenosis, we performed one-stage dilatation plasty of the pulmonary artery branch bifurcation with autopericardium. During the repeated surgery we faced such a serious complication as aortic damage for the first time, thanks to emergency actions it did not turn out to be fatal. We also managed to perform the most preferable dilation of hypoplastic branches of the pulmonary artery by plasty with the own tissues of the superior vena cava during the formation of Glenn-anastomosis.Received 29 November 2021. Revised 21 December 2021. Accepted 22 December 2021.Informed consent: Informed consent was obtained from the patient's mother for the publication and use of the patient's medical data for scientific purposes.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.Contribution of the authorsLiterature review: A.V. MishinDrafting the article: A.V. MishinCritical revision of the article: K.N. Kuatbekov, A.D. SepbayevaSurgical treatment: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. KanzhigalinFinal approval of the version to be published: K.N. Kuatbekov, A.V. Mishin, A.D. Sepbayeva, G.S. Nigay, D.M. Kanzhigalin

Treatment of non-restrictive cor triatriatum sinister during concomitant cardiac surgery

BackgroundCor triatriatum is a rare congenital heart disease representing the 0.4% of all congenital cardiac anomalies. To date, no specific genetic alteration has been associated to cor triatriatum. The left-sided presentation (cor triatriatum sinister (CTS)) generally consists in a fibromuscular membrane that divides the left atrium into two chambers, therefore generating a varying grade of flow obstruction depending on the shape, location, and membrane fenestration size. Cor triatriatum sinister can be isolated or associated to other congenital heart defects such as ostium secundum atrial septal defect, patent foramen ovale or abnormal pulmonary veins drainage.Case presentationOur case is a 63-year-old woman who was diagnosed with a non-restrictive membrane during a hospitalization for acute heart failure. In the following 6 months, she started to become symptomatic. However, the onset of symptoms was more likely related to mitral valve regurgitation worsening and previously unknown coronary artery disease, rather than to CTS. She underwent bi-atrial surgical ablation (Cox Maze IV procedure) for atrial fibrillation (AF), surgical resection of interatrial membrane with mitral annuloplasty, and myocardial revascularization.ConclusionThe onset and severity of symptoms in patients with CTS mostly depend on membrane fenestration size, grade of stenosis generated and pulmonary veins drainage site. However, some cases may remain asymptomatic until adulthood; the degree of pulmonary hypertension and congestive heart failure is determined by the presence of additional cardiac anomalies and the fibromuscular membrane fenestration. In some cases, CTS may remain asymptomatic, thus the diagnosis can be incidental.

Treatment of intragraft stenosis in hemodialysis grafts with Supera stents: A retrospective study.

To report the patency rates after implantation of an interwoven nitinol stent to salvage failing arteriovenous grafts (AVGs) caused by intragraft stenoses. Between May 2018 and May 2020, 21 Supera stents were placed in 20 patients (18 women; mean age: 79.9 years) who had a failing AVG due to repeat intragraft stenoses. Recurrent AVG dysfunction with same intragraft stenosis within 3 months after first time angioplasty was a criterion for stenting. Those with concurrent treatment for other lesions were excluded. The technical success rate was 100%. Intragraft stenoses were treated at a median of 19.7 (interquartile range: 6-36) months after graft creation. Access circuit primary patency rates after stent placement were 84% and 35% at 6 and 12 months, respectively. Access circuit secondary patency rates were 100% at 6 and 12 months and 89% at 18 months. Only one patient presented with graft failure due to proximal drainage vein occlusion. The target lesion patency rates were 100% at 6 months and 75% at 12 months. The rate of reintervention for intragraft lesion was 0.15 procedures per year. Stent distortion did not occur under regular cannulation. The interwoven nitinol stent is a promising treatment for failing AVGs with recurrent intragraft stenoses. The 1-year access circuit primary, secondary, and target lesion patency rates were acceptable, with a low reintervention rate. Stent fracture does not occur in areas of needle puncture.

Intraoperative Monitoring Cerebral Blood Flow During the Treatment of Brain Arteriovenous Malformations in Hybrid Operating Room by Laser Speckle Contrast Imaging.

BackgroundHemodynamic changes caused by hybrid surgery for brain arteriovenous malformations (bAVM) are usually related to long-term lesions from “blood stealing”. There are currently no viable low-cost, noninvasive procedures for assessing cerebral perfusion in the operating room. This study aims to investigate the use of intraoperative laser speckle contrast image (LSCI) software in AVM surgery.MethodsIn Zhongnan Hospital of Wuhan University, 14 patients who underwent surgery with LSCI were collected. To analyze the hemodynamic features of AVM and the influence on the peripheral cortex of AVM embolization and resection, we assessed the transit time between feeding arteries and drainage veins by intraoperative digital subtraction angiography (DSA). Meanwhile, LSCI was performed at pre-embolization, post-embolization, and after complete resection of bAVM.ResultsIn this study, the transit time of bAVM before and after embolization was compared, the transit time before embolization was significantly shorter than that after embolization (p < 0.05). We also got good visualization of relative CBF, in addition, to flow imaging in the cortical vasculature round bAVM with LSCI. The flux of post-surgery was significantly higher than pre-embolization (p < 0.01).ConclusionHemodynamic variable assessment plays an important role in the resection of AVM in the hybrid operative room and LSCI can be used to visualize and evaluate cortical cerebral blood flow to detect pathological hyperperfusion in real-time with a good spatial-temporal resolution in a sensitive and continuous, non-invasive mode.

Anomalous great cardiac vein draining into juxtaposed right atrial appendage

We present a case of a 2-year-old boy with a double outlet right ventricle and juxtaposed atrial appendages with anomalous drainage of the great cardiac vein into the aneurysmally dilated juxtaposed right atrial appendage. The case highlights the role of computed tomography(CT) angiography in depicting anomalous coronary venous anatomy and guiding therapeutic interventions involving the coronary venous approach.

Case Study: Exploring a Variation of Partial Anomalous Pulmonary Venous Return of the Right Upper Pulmonary Vein into the Cephalic Portion of the SVC Causing a Left‐to‐Right Shunt in a 56‐year‐old Asian Female

HypothesisPartial Anomalous Pulmonary Venous Return is the result of aberrant congenital cardiopulmonary development, and can go undiagnosed with late emergent presentation in older adulthood.SummaryPartial Anomalous Pulmonary Venous Return (PAPVR) is a highly variable disease that is often asymptomatic in children and may not present until later in adulthood either symptomatically, or as an incidental finding on radiology or autopsy. When considering the configuration of anatomic congenital anomalies, such as PAPVR in both children and adults, it is important to explore the embryological development. Due to the direct correlation between the cardiology and pulmonology in this case, the embryology of both systems must be understood and discussed to fully recognize the issue at hand and is further explored in detail later. The most common presentation of PAPVR involves the right upper pulmonary vein as it drains into the junction of the Superior Vena Cava (SVC) and right atrium creating a left‐to‐right shunt, and there is almost always an associated Atrial Septal Defect (ASD) present in PAPVR[1]. In the case presented, a 56‐year‐old Asian female was found to have PAPVR of the Right Upper Pulmonary Vein that drained into the cephalic portion of the SVC. A left‐to‐right shunt results in freshly oxygenated blood from the lungs being returned to, and mixed with, deoxygenated systemic blood in the right atrium. While having a right upper pulmonary vein drain into the SVC is the most common PAPVR, this case is rare as it is not associated with an ASD as previously described[2]. The abnormal site of attachment of the right pulmonary vein was noteworthy, because in most cases this vein will attach at the junction of the SVC and right atrium. In this case, the vein was draining into the cephalic portion of the SVC alone. This patient required a modified Warden’s procedure for successful surgical correction. While most cases are asymptomatic and the result of an incidental finding, the patient presented to the emergency department with a life‐threatening right atrial pressure of 80mmHG, which is clinically significant for Pulmonary Arterial Hypertension (PAH) and caused the patient to go into Right‐Sided Heart Failure. The patient also presented with significant right ventricular hypertrophy, as the result of consistent PAH.ConclusionPAPVR is a rare congenital cardiopulmonary defect that can remain undiagnosed and present later in adulthood. The diagnosis and treatment of this disease is particularly difficult due to its ability to remain undetected in childhood, slowly progress to insidious pathology, and present later in adulthood with potentially life‐threatening complications requiring surgical intervention. The variability of PAPVR must be explored further in order to improve the effective diagnosis and treatment of this rare congenital disease.Resources[1] Lyen, S. et al.2017. Anomalous pulmonary venous drainage: a pictorial essay with a CT focus. J Congenit Heart Dis[2] Ishida, N et al.2018. Surgical repair of partial anomalous pulmonary venous return with intact atrial septum in a 65‐year‐old woman: a case report. Journal of medical case reports