A 5-year-old Caucasian boy was referred for heart murmur. Echocardiography showed a dilated right ventricle, no atrial septal defect but a partial anomalous pulmonary venous return of the right lung into the innominate vein, which was confirmed by 3D CT (Movie 1). Cardiac catheterisation showed normal pulmonary artery pressures and a significant left-to-right shunt (Qp:Qs = 2). Pulmonary artery angiography with 3D rotational angiography confirmed partial anomalous pulmonary venous return of the entire right lung to a vertical vein (Fig 1A and B, plain arrow) connected to the innominate vein, whilst it unmasked a dual drainage of the three right pulmonary veins to the left atrium (Fig 1B, dotted arrows; Movie 2); the two left pulmonary veins were normally connected to the left atrium (Fig 1B, dotted arrows). Balloon occlusion test of the vertical vein using a 18 × 20 mm Tyshak-II balloon dilatation catheter with simultaneous pulmonary artery angiography demonstrated normal drainage of the three right pulmonary veins into the left atrium (Fig 1C). After multidisciplinary team discussion, transcatheter occlusion of the vertical vein was successfully performed using a 14 mm Amplatzer Vascular Plug-II (Fig 1D). The 1-year follow-up has been uneventful.
Partial anomalous pulmonary venous return is a rare CHD affecting 0.039‰ livebirths. Midline crossing of pulmonary veins is exceptional. Partial anomalous pulmonary venous return with additional drainage to the left atrium has been occasionally reported, allowing for transcatheter therapy, although world experience remains limited. Reference Luciano, Laux and Boudjemline1 We believe clinicians should be aware of this rare entity and strive to look for it, as it may change the decision-making process, avoiding open-heart surgery.
Supplementary material
For supplementary materials referred to in this article, please visit https://doi.org/10.1017/S1047951123000161
Acknowledgements
We gratefully acknowledge Dr Hélène Ansquer (Brest, France), GCS HUGO, and AVIESAN.
Financial support
A.-E.B. is supported by the French Government as part of the “Investments of the future” programme managed by the National Research Agency (grant reference ANR-16-IDEX-0007); FHU PreciCare.
Conflicts of interest
A.-E.B. is consultant and proctor for Abbott and Occlutech. The other authors have nothing to disclose.
Ethical standards
The authors assert that all procedures contributing to this work comply with the Helsinki Declaration of 1975, as revised in 2008.