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PAPVRPartial Anomalous Pulmonary Venous Return
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It is important to be familiar with PAPVR as a cause of CVL malposition.
Table 1: Summary of the approach followed in 10 cases reported in literature of adult patients found to have PAPVR on CVL insertion.
To our knowledge, this is the first case that described a left-sided upper PAPVR through a "curved" vein, which goes first inferiorly and then medially to the left pulmonary artery to join the left brachiocephalic vein, because the cases of left-sided upper PAPVR reported in the literature typically present a "vertical" vein located laterally to the left pulmonary artery.
Partial anomalous pulmonary venous return (PAPVR) is a rare congenital abnormality in which one or more (but not all) of the pulmonary veins drain to the right atrium, directly or most frequently through one of its tributary veins [4].
PAPVR arises from the failure of one or more of the pulmonary veins' connection with the common pulmonary vein and with the lack of the regression of part of primitive lung drainage to systemic vein [5].
Many authors suggest that right-sided PAPVR occurs twice as often as left-sided PAPVRs.
Right-sided PAPVR consists of anomalous drainage of a right pulmonary vein to superior vein cava, azygos vein, coronary sinus, or inferior vena cava.
Left-sided PAPVR usually drains into the left brachiocephalic vein, often through a vertical vein.
Although PAPVR normally drains into a vessel located in the proximity, that is, into right-sided vein for right lung pulmonary veins and into a left-sided vein for the left lung pulmonary veins, some rare cases of "cross mediastinal drainage" are reported [7].
However, we cannot consider it to be a very rare finding associated with PAPVR, because most of the cases of PAPVR reported in the literature do not clearly reveal if they are associated with any accessory pulmonary veins.
PAPVR may be suspected at echocardiography; however, the lack of adequate acoustic windows makes it difficult to detect through this diagnostic technique [5].