Atrial septal defect (upper sinus venosus type) with partial anomalous pulmonary venous return into superior vena cava

Case contributed by Dr Fabien Ho

Presentation

Abnormal echocardiographic findings.

Patient Data

Age: 40 years
Gender: Male

Enlarged right ventricle (RV), main pulmonary artery (MPA), left and right PAs suggesting preload pulmonary hypertension.

The right upper pulmonary vein drains into the right superior vena cava. 
atrial septal defect (ASD), upper sinus venosus type also concerning for septum secundum. No posterior bank between both atria, superior vena cava and the PAPVR. There is an anterior bank towards the aorta.

An accessory pulmonary vein also drains into the ASD.

At the lower side of the interatrial septum there is a 10mm bulging towards LA, which is the cut-off limit above which are defined aneurysms.

Images focusing on the ASD and PAPVR.

Arrow: right upper pulmonary vein draining into the right superior vena cava. 

The anterior bank towards the aorta is measured (12mm).

Case Discussion

This case features the classic association of an atrial septal defect (ASD), upper sinus venosus type, with partial anomalous pulmonary venous return (PAPVR) into superior vena cava.

This patient had a cardiac ultrasound examination beforehand which found: ASD septum secundum and most likely sinus venosus as well, with a gap of 26mm. No posterior bank, hence surgical indication. The cardiologist was then looking for associated PAPVR. 

No posterior bank between both atria, SVC and the PAPVR: this means that percutaneous closure would most likely fail, hence the surgical indication.

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