[HSF] ask Pasanna

[Donald Ross]

Prasanna, the CXR and TOE were  unremarkable and the offending vein  
was divided to achieve the prime objective: apical dislocation of the  
heart to enable opcab radial to PDA.
The miracle of the encounter was that I didn't divide it in one snip  
as  it was masquerading as an adhesion.
Thanks for the expected expert opinion.
Don
On 03/01/2007, at 9:00 PM, Prasanna Simha M wrote:

> One more quick shot
>
> *Partial anomalous pulmonary venous return*
>
> In PAPVR, not all pulmonary veins drain abnormally. One or more  
> pulmonary
> veins abnormally return to the superior or inferior vena cava, the  
> right
> atrium, or the coronary sinus.
> Ultimately itwas a PAPVC to CS. Did you draw samples from RA RV and  
> PA ? to
> determine the shunt. If it was insignificant you could just leave it
> alone.(Especially if itwas just one vein). I would be curious to  
> see the
> chest X Ray of this patient.
> What did you do ultimately ?
> Prasanna
>
> On 1/3/07, Prasanna Simha M <prasannasimha at gmail.com> wrote:
>>
>> I am in th hospital and so a quick response - will look in detail  
>> later.
>> * * Jpn J Thorac Cardiovasc Surg. 1998 Nov;46(11):1211-4. Related
>> Articles,
>> <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? 
>> itool=pubmed_Abstract&db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_u 
>> id=9884580&itool=ExternalSearch>
>> Links
>> *[Surgical repair of coronary sinus type partial anomalous pulmonary
>> venous drainage with intact atrial septum]*
>>
>> [Article in Japanese]
>>
>> *Aoki A*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? 
>> db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Aoki+A%22% 
>> 5BAuthor%5D>,
>> *Kubota T*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? 
>> db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Kubota+T%22% 
>> 5BAuthor%5D>,
>> *Nakai M*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? 
>> db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Nakai+M%22% 
>> 5BAuthor%5D>,
>> *Inoue M*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? 
>> db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Inoue+M%22% 
>> 5BAuthor%5D>,
>> *Sano S*<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi? 
>> db=pubmed&cmd=Search&itool=pubmed_Abstract&term=%22Sano+S%22% 
>> 5BAuthor%5D>
>> .
>>
>> Department of Cardiovascular Surgery, Okayama University Medical  
>> School,
>> Japan.
>>
>> We experienced a rare form of PAPVD without atrial septal defect. The
>> patient was a 33-year-old male and he was referred to our  
>> institute because
>> of mild right pulmonary congestion detected by a routine chest X- 
>> P. Enlarged
>> coronary sinus, right atrium and right ventricle were documented  
>> by UCG. The
>> Qp/Qs was 1.9 and pulmonary artery pressure was 38/7 mmHg (mean:  
>> 17 mmHg)
>> by cardiac catheterization. Selective pulmonary angiogram showed  
>> that all
>> right pulmonary veins drained into the coronary sinus without  
>> evidence of an
>> atrial septal defect. Enhanced chest CT clearly demonstrated the  
>> connection
>> between the right pulmonary vein and the coronary sinus.  
>> Intracardiac repair
>> without atrial baffle was carried out under hypothermic  
>> cardiopulmonary
>> bypass. Under cardiac arrest with cardioplegia, the common wall  
>> between the
>> right pulmonary vein and the left atrium was incised and the  
>> connection
>> between the right pulmonary vein and the left atrium was  
>> established. The
>> flap made by this incision was brought posterior to close the right
>> pulmonary vein opening to the coronary sinus. The postoperative  
>> course was
>> uneventful and the minimum diameter of the right pulmonary vein  
>> was found to
>> be 15.5 mm by a postoperative pulmonary artery angiogram. This  
>> operative
>> method without an atrial baffle could be an alternative procedure for
>> coronary sinus type PAPVD.
>>
>> Publication Types:
>>
>>    - Case Reports
>>    - English Abstract
>>
>>
>> PMID: 9884580 [PubMed - indexed for MEDLINE]
>>
>> On 1/3/07, Donald Ross <donross at bigpond.com> wrote:
>> >
>> > I came across a congenital abnormality I had not previously
>> > encountered today.
>> > While upending the heart for a pda graft I noticed what looked  
>> like a
>> > pericardial adhesion a 4 cm left of the IVC. I hoed into it with  
>> the
>> > scissors but could not find a plane so started dissecting and  
>> found a
>> > 0.5cm vein connecting the coronary sinus to presumably the L  
>> lower lobe.
>> > I guess it was an aberrant pulmonary vein?
>> > Don
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>>
>>
>>
>> --
>> Prasanna Simha M
>
>
>
>
> -- 
> Prasanna Simha M
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