Total Anomalous Pulmonary Venous Connection in a 64-Year-Old Man: A Case Report

Abstract

We report a 64-year-old man with incidentally found uncorrected total anomalous pulmonary venous connection (TAPVC). There have been only a few case reports of untreated TAPVC diagnosed after 60 years of age. Also, this is a first case report of TAPVC in which ECG-gated CT and phase-contrast cine magnetic resonance imaging (PC-MRI) was performed. He was referred to our hospital for the surgery of rectal cancer. He had been diagnosed to have an arterial septal defect (ASD) and persistent left superior vena cava (PLSVC), and Eisenmenger's syndrome was thought to be the cause of cyanosis at first. The vertical vein in TAPVC was initially misdiagnosed as PLSVC on enhanced axial CT images reconstructed with 5-mm slice thickness with gapless. ECG-gated CT and PC-MRI were useful to confirm the diagnosis. The vertical vein in TAPVC is morphologically similar to PLSVC. This kind of abnormality would be somewhat difficult to diagnose on non-ECGgated CT, and might be misdiagnosed as a large ASD and PLSVC.Keywords: total anomalous pulmonary venous connection (TAPVC), adult, phase-contrast MRI, ECG-gated CT, persistent left superior vena cava (PLSVC) diagnosed after 60 years of age. 2,3) Also, this was a unique case report of TAPVC in which ECG-gated CT and phase-contrast cine magnetic resonance imaging (PC-MRI) was performed. Case ReportA 64-year-old man was referred to our hospital for the surgery of rectal cancer. He had been diagnosed to have an arterial septal defect (ASD) at the age of 26 years. Cyanosis, secondary polycythemia, and arterial fibrillation were found at age 53. Persistent left superior vena cava (PLSVC) was suspected on unenhanced CT at age 58. Because he showed a low level of percutaneous oxygen saturation (84%) on pre-operative routine laboratory examinations, further examinations were performed to confirm the diagnosis.Non-ECG-gated contrast-enhanced CT revealed an abnormal vessel at the left side of the heart that connected to the brachiocephalic vein. Although this vessel originated from the brachiocephalic vein, which was

Computed tomography features of supracardiac total anomalous pulmonary venous connection in an infant

“…[1] The incidence of this rare entity is approximately 1 of 17,000 live births [2] or 1%-5% of all cardiovascular congenital anomalies [3].…”

Total anomalous pulmonary venous return repair in adult patients

“…Поздняя выявляемость и соответственно коррекция ТАДЛВ объясняются «асимптомным», то есть относи-тельно благоприятным клиническим течением порока у ряда пациентов II-IV декад жизни, и отказом от предла-гаемой операции [1,19,21,22,[26][27][28][29][30][31]. Курьезными при-мерами «асимптомного» течения ТАДЛВ служат наблюде-ния B. McManus и соавт.…”

“…-минимальная/умеренная недостаточность трику-спидального клапана (ТК) [1,5,11,[17][18][19][20][21][25][26][27][28]. До-полнительный предиктор выживаемости больных при естественном течении порока -сопутствующий клапан-ный стеноз легочной артерии/сужение выходного отдела правого желудочка (ВОПЖ), предотвращающие развитие ЛГ.…”

“…Наиболее точная верификация анатомического типа ТАДЛВ и варианта дренажа легочных вен непосредственно в ПП/системные вены или общим венозным коллектором достигается при контрастной МСКТ/МРТ [11,19,21,26,29,30]. У взрослых больных с ТАДЛВ и недостаточностью ТК III-IV степени переключение кровотока аномально дренирующихся легочных вен в артериальную циркуляцию целесообразно дополнять коррекцией недостаточности ТК [11].…”

“…Взрослая популяция ТАДЛВ отличается от педиатри-ческого контингента больных [6,9,12,13,15,24] изолиро-ванными формами порока без обструкции легочных вен, сопутствующих ВПС и гетеротаксии [1,5,7,9,[16][17][18][19][20][21][22][23][26][27][28][29][30][31]. Исключение составляют 4 взрослых больных с ТАДЛВ и сопутствующим клапанным стенозом легочной артерии/ сужением выходного отдела правого желудочка (ВОПЖ), оперированных в возрасте 26, 47, 52 и 56 лет [9,19,22].…”