Hegde Madhav, Manjunath Satvik Cholenahalli, Usha M K
Department of Radiology, BGS Global Institute of Medical Sciences, Bengaluru, Karnataka, India.
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India.
J Clin Imaging Sci. 2019 Jun 14;9:29. doi: 10.25259/JCIS-8-2019. eCollection 2019.
Partial anomalous pulmonary venous connection (PAPVC) is one of the rare congenital cardiac diseases with a prevalence of 0.4-0.7% of autopsies. The prevalence of a partial anomalous pulmonary venous connection is 0.2% in computed tomography (CT) among adults. We chose to study the association between isolated PAPVC and volume overload, estimated systolic pulmonary artery pressure in a tertiary care center for cardiovascular diseases.
CT report database was searched for keywords of partial anomalous pulmonary venous connection, pulmonary hypertension, dilated right atrium (RA), and right ventricle (RV). Both pediatric and adult population were considered. All the dedicated studies of non-coronary cardiac evaluation, pulmonary arteries, and thorax were included in the study. Echocardiography was performed in all the subjects. In adults, abnormalities searched were features of volume overload of RA and RV and estimated systolic pulmonary pressure of 45 mmHg. Biphasic studies were performed, and upper abdomen was included in the CT studies.
Among the 110 subjects, 54 (49%) had isolated PAPVC. Of 54, 26 patients had volume overload of RA/RV or elevated estimated systolic pulmonary artery pressure. There is a significant association between drainage of anomalous veins to superior vena cava (SVC) and age >18 years (Chi-squared test = 0.003). Among patients with isolated PAPVC, 18 had anomalous drainage to the SVC. Among isolated PAPVC cases, 38 were of the age >18 years. We found statistically significant association ( = 0.02) between isolated PAPVC in adults and pulmonary hypertension.
Isolated PAPVC has association with the development of pulmonary hypertension in adults, approaching statistically significant p value. Because isolated PAPVC is a clinically significant independent risk factor, it should be actively treated to prevent the development of pulmonary hypertension later in life, which may result in severe clinical consequences.
部分性肺静脉异位连接（PAPVC）是一种罕见的先天性心脏病，在尸检中的患病率为0.4 - 0.7%。在成人计算机断层扫描（CT）中，部分性肺静脉异位连接的患病率为0.2%。我们选择在一家心血管疾病三级护理中心研究孤立性PAPVC与容量超负荷、估计的收缩期肺动脉压之间的关联。
在CT报告数据库中搜索部分性肺静脉异位连接、肺动脉高压、右心房（RA）扩张和右心室（RV）扩张的关键词。纳入儿童和成人人群。所有非冠状动脉心脏评估、肺动脉和胸部的专项研究均纳入本研究。所有受试者均进行了超声心动图检查。在成人中，搜索的异常情况为RA和RV容量超负荷的特征以及估计收缩期肺动脉压≥45 mmHg。进行了双期研究，CT研究包括上腹部。
在110名受试者中，54名（49%）有孤立性PAPVC。在这54名患者中，26例有RA/RV容量超负荷或估计的收缩期肺动脉压升高。异常静脉向上腔静脉（SVC）引流与年龄>18岁之间存在显著关联（卡方检验 = 0.003）。在孤立性PAPVC患者中，18例有向上腔静脉的异常引流。在孤立性PAPVC病例中，38例年龄>18岁。我们发现成人孤立性PAPVC与肺动脉高压之间存在统计学显著关联（p = 0.02）。
孤立性PAPVC与成人肺动脉高压的发生有关，p值接近统计学显著性。由于孤立性PAPVC是一个具有临床意义的独立危险因素，应积极治疗以预防后期发生可能导致严重临床后果的肺动脉高压。
