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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 11  |  Issue : 2  |  Page : 140-141
Transoesophageal echocardiography during surgery for atrial septal defect with partial anomalous pulmonary venous connection


Department of Anaesthesiology Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

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How to cite this article:
Gadhinglajkar S, Sreedhar R. Transoesophageal echocardiography during surgery for atrial septal defect with partial anomalous pulmonary venous connection. Ann Card Anaesth 2008;11:140-1

How to cite this URL:
Gadhinglajkar S, Sreedhar R. Transoesophageal echocardiography during surgery for atrial septal defect with partial anomalous pulmonary venous connection. Ann Card Anaesth [serial online] 2008 [cited 2020 Jan 21];11:140-1. Available from: http://www.annals.in/text.asp?2008/11/2/140/41597


The Editor,

A 24-year-old female patient was diagnosed to have a 26-mm ostium secundum atrial septal defect (ASD) and mild pulmonary hypertension on preoperative transthoracic echocardiography (TTE). As TTE failed to identify the course of right lower pulmonary vein (RLPV), the patient was subjected to angiography to exclude presence of Scimitar syndrome (hypoplasia of the right lung and right pulmonary artery; anomalous drainage of right pulmonary veins; and anomalous arterial supply of the right lower lobe from the abdominal aorta). It revealed RLPV draining into hepatic vein; absence of communication between RLPV and left atrium (LA); and normal drainage of other pulmonary veins. Hence she was scheduled for surgical closure of ASD, disconnection of RLPV from hepatic vein, and its direct anastomosis to LA.

After induction of anaesthesia, transoesophageal echocardiography (TOE) examination was performed, which showed opening of RLPV into inferior vena cava (IVC) 1 cm proximal to hepatic venous opening [Figure 1]. This finding was also confirmed by the surgeon after sternotomy. Hence direct anastomosis of RLPV to LA was deferred. On CPB with deep hypothermic circulatory arrest, the IVC-right atrium (RA) junction was incised to visualize the RLPV and hepatic vein openings. Both veins were found opening separately inside the IVC. A tanned pericardial patch was used to reroute the RLPV drainage into LA through ASD, which closed ASD as well. The hepatic vein and IVC continued to drain into the RA. TOE navigation after termination of cardiopulmonary bypass showed adequate flow in the rerouted RLPV, hepatic vein [Figure 2], and IVC [Figure 3]. Ten percent to 15% of ostium secundum atrial septal defects are associated with partial anomalous pulmonary venous connections (PAPVC). TOE is highly diagnostic for PAPVC and can obviate angiography. Accurate anatomic diagnosis may influence surgical management. [1] Pericardial patch may obstruct the flow of rerouted pulmonary vein and IVC, which should be ruled out after weaning the patient from CPB.

 
   References Top

1.Ammash NM, Seward JB, Warnes CA, Connolly HM, O'Leary PW, Danielson GK. Partial anomalous pulmonary venous connection: Diagnosis by transesophageal echocardiography. J Am Coll Cardiol 1997;29:1351-8.  Back to cited text no. 1    

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Correspondence Address:
Shrinivas Gadhinglajkar
Department of Anaesthesia, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum - 695 011, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9784.41597

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