Partial anomalous venous return
Partial anomalous pulmonary venous return poses a diagnostic challenge to non-invasive
imaging though it can be reliably detected at right heart catheterization by a rise in O2
saturation in the proximal right atrium. Most PAPVR consists of right pulmonary veins
draining into the superior vena cava or right atrium. Association with sinus venosus defect
is frequent.
Where the partial anomalous vein arises on the left, there is often a vertical vein
draining into the brachiocephalic vein.
Right pulmonary veins draining into the IVC usually produce a configuration described as
"scimitar syndrome." This is more often associated with an intact atrial septum and other
anomalies, including hypoplasia of the right lung.
Transesophageal angulated view with the SVC to the viewer's right. The
triangular tissue channel at the junction of the right atrium represents the partial
anomalous veins from the right.
Transesophageal angulated view centered on the right lower anomalous
pulmonary vein (horizontal channel, mid-screen) which flows into the SVC. The larger
structure above it in the image is the left atrium.
Transesophageal angulated view centered on the tricuspid valve and
inter-atrial septum shows the enlarged right atrium and right atrial appendage with the SVC
entering at about 3 o'clock.
Transesophageal angulated view of inter-atrial septum, right atrium,
tricuspid valve and right ventricular outflow tract shows the increased volume resulting
from the PAPVR shunt.
Composite image showing three separate catheter passes from the
IVC and right atrium in which the catheter tip enters individual right pulmonary veins
which are draining into the superior vena cava. These partial anomalous pulmonary veins
accompany a sinus venosus atrial septal defect.
Catheter is positioned retrograde into right pulmonary veins and
shows drainage into the superior vena cava indicating partial anomalous pulmonary venous
return on the right. The sinus venosus defect of the atrial septum is not demonstrated at
this point.
Routine chest X-ray of this 14 year old girl suggests prominent right
heart borders on the two views. There is also prominence of the pulmonary artery segment
due to pulmonary overcirculation from partial anomalous right pulmonary veins draining into
the SVC and an associated atrial sinus venosus defect.
These pre- and post-op 4 chamber views show the panel of tissue (arrow)
in an arc at the posterior atrial septum which covers and channels the blood flow from the
right partial anomalous pulmonary veins in the right atrium into the left atrium.
