Cardiovasc Imaging Asia.  2022 Jul;6(3):96-100. 10.22468/cvia.2022.00052.

The Importance of Pulmonary Vein Drainage Assessment in Secundum-type Atrial Septal Defect Patients: Where Did It Go?

Affiliations
  • 1Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia

Abstract


Objective
Partial anomalous pulmonary vein drainage (PAPVD) describes a pattern where ≥1, but not all, pulmonary veins do not drain into the left atrium. It has traditionally been associated with atrial septal defects (ASDs). Due to silent clinical manifestations, a PAPVD diagnosis can pose a challenge for physicians. Trans-thoracic echocardiography (TTE) is used to diagnose PAPVD yet sometimes provides insufficient information. This study sought to observe the clinical characteristics of PAPVD patients, diagnostic modalities, and the relationship of PAPVD to ASD diagnosis.
Materials and Methods
We collected medical records data of PAPVD patients seen at our centre, the National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia, from January 2012 to May 2021.
Results
This study included 84 patients. Initial TTE examinations were performed in all cases. Concomitant ASD was seen in 95.2% of the patients, with 65.5% of cases being the sinus venous defect type and the rest being the secundum type. An inability to determine PAPVD diagnosis through initial TTE exam occurred in 26.2% of patients. From that group, most of the PAPVD diagnoses were determined through right heart catheterisation (54.5%); others were confirmed using intraoperative findings (22.7%), computed tomography imaging (13.6%), magnetic resonance imaging (4.5%), and trans-esophageal echocardiography (4.5%). The backward regression model showed that the type of ASD (p=0.023) and age (p=0.024) are predictors of diagnostic discrepancy, with odds ratios for the type of ASD and age being 3.93 and 1.04.
Conclusion
Older PAPVD patients with secundum-type ASD pose a greater diagnostic challenge to determining pulmonary vein drainage during the initial TTE exam examination.

Keyword

Atrial septal defect; Partial anomalous pulmonary vein drainage; Diagnosis; Transthoracic echocardiography
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