[HSF] ask Pasanna

Mon Jan 8 07:48:36 EST 2007

How is the X ray post op. Is there any localized pulmonary edema due to 
PV ligation ? If it was piercing the diaphragm another possibility would 
have been extralobar sequestration of the lung but then your X Ray would 
have shown something.
If you
 Thanks for the interesting case .
Prasanna
Donald Ross wrote:
> 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_uid=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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