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      Anomalia parcial de retorno venoso pulmonar a propósito de un caso Translated title: Partial anomaly of pulmonary venous return, case report APRVP

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          Abstract

          Resumen La anomalía de drenaje o de retorno venoso pulmonar es la inapropiada conexión de las venas pulmonares hacia venas sistémicas, puede ser parcial (de una a tres de las venas pulmonares) o total (todas las venas pulmonares comprometidas). Esta patología pertenece al grupo de cardiopatías congénitas cianóticas con hiperflujo pulmonar. Se presenta el caso de un niño de 6 años de edad, con el diagnóstico de anomalía parcial de retorno venoso pulmonar tipo supracardiaco (retorno de venas pulmonares izquierdas hacia vena innominada) y Coartación de Aorta, diagnosticados desde sus 10 días de vida, a los 5 meses fue operado de Coartación de Aorta, y a los 6 años se realizó la corrección de la anomalía parcial de retorno venoso pulmonar. Clínicamente asintomático, con presencia de soplo sistólico en foco pulmonar y aumento del segundo ruido cardiaco. Entre los datos ecocardiográficos resaltan: Válvula aórtica bicúspide, hipertensión arterial pulmonar leve (PAPS 40 mmHg), para 3600 m.s.n.m. Se realizó cirugía correctora con óptima recuperación y tras un seguimiento de tres años el paciente se encuentra asintomático, con presión pulmonar normal, sin arrítmias ni obstrucciones a nivel de las venas pulmonares.

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          Diagnosis and Management of Partial Anomalous Pulmonary Venous Connection

          Medical records, angiograms and operative records of 28 patients with partial anomalous pulmonary venous connection (PAPVC) were reviewed. Twenty patients had one anomalous pulmonary vein (APV), and 8 had more than two APVs. Twenty-five patients (89%) had APVs originating from the right lung, 2 (7%) from the left lung and 1 (4%) from both lungs. In the 25 patients with APVs originating from the right lung, 9 had APVs draining into the superior vena cava (SVC), 13 into the right atrium (RA), 1 into the inferior vena cava (IVC) and 2 into both the SVC and RA. In the 2 patients with APVs originating from the left lung, 1 had APVs draining into the RA, and the other had APVs draining into the innominate vein. The patient with APVs originating from both lungs had connection to the IVC. Twenty-three patients (82%) had additional cardiovascular defects. Surgery was performed in 13 patients who had pulmonary/systemic flow ratios greater than 2.0. The patients have done well after surgery. In 7 patients, we were unable to accurately determine the number or sites of drainage of APVs prior to surgery. We conclude that selective pulmonary angiography is indispensable for the accurate diagnosis of PAPVC.
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            Partial anomalous pulmonary venous connection to the right side of the heart.

            Partial anomalous pulmonary venous connection to the right side of the heart often complicates surgery for atrial septal defects. Between 1964 and 1987, 39 patients, ranging from 2 to 52 years old, underwent repair of partial anomalous pulmonary venous connection. At least one anomalous pulmonary vein arose from the right upper lobe in 38 patients and right middle lobe in 30 patients and connected to the superior vena cava in 28 patients and the right atrium only in 11 patients. An atrial septal defect was present in 32 patients (82%). Patients who had partial anomalous pulmonary venous connection to the superior vena cava-right atrium junction, the right atrium or both were treated by septal translocation (two patients) or patch redirection of the anomalous pulmonary venous flow to the left atrium through a native atrial septal defect (eight patients) or a surgically created atrial septal defect in two patients with intact atrial septum. For partial anomalous pulmonary venous connection to the high superior vena cava (27 patients), the superior vena cava was transected and oversewn above the anomalous veins. The anomalous pulmonary venous flow was redirected through the proximal superior vena cava into the left atrium across a sinus venous atrial septum defect (22 patients) or a surgically created atrial septal defect in five patients with intact atrial septum. The atrial septal defect was coapted to the intracardiac orifice of the superior vena cava, and the distal superior vena cava was anastomosed to the right atrial appendage. One 31-year-old woman with severe pulmonary hypertension died early and was the only death in the series. A technical error early in the series resulted in one symptomatic superior vena cava obstruction. Only one patient remains in sick sinus syndrome late. All patients remain well over long follow-up (1 to 24 years). Postoperative catheterization or echocardiography has revealed no intracardiac defects, pulmonary venous obstruction, or superior vena cava obstruction (except the one technical error). Correction of partial anomalous pulmonary venous connection should be individualized according to the site of connection of the anomalous pulmonary veins and the location of the atrial defect to minimize undesirable postoperative sequelae often associated with other methods of repair.
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              Anomalous pulmonary veins

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                Author and article information

                Journal
                chc
                Cuadernos Hospital de Clínicas
                Cuad. - Hosp. Clín.
                Universidad Mayor de San Andrés, Facultad de Medicina (La Paz, , Bolivia )
                1562-6776
                2019
                : 60
                : Especial
                : 45-49
                Affiliations
                [01] La Paz orgnameUniversidad Mayor de San Andrés Bolivia ck.vargasvasquez@ 123456gmail.com
                Article
                S1652-67762019000300007 S1652-6776(19)06000000007
                b2643242-967e-4246-8c52-4e53cdc02799

                This work is licensed under a Creative Commons Attribution 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 13, Pages: 5
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                SciELO Bolivia

                Categories
                CASOS CLÍNICOS

                anomalía de retorno venoso pulmonar,cirugía correctora,cardiopatía congénita

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