Importance of identifying the direction of pulmonary venous flow in diagnosing a cavopulmonary window: A case report and review of literature. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Nitta, Manabu; Nakashima, Rie; Kino, Tabito; Matsumoto, Yusuke; Nakayama, Mina; Iwata, Kiwamu; Matsumoto, Katsumi; Sugano, Teruyasu; Ishigami, Tomoaki; Ishikawa, Toshiyuki; Tamura, Koichi; Kimura, Kazuo
• Is Part Of: Journal of cardiology cases. Volume 21:Issue 5(2020)
• Page Start: 179
• Page End: 181
• Publication Date: 2020-05
• Subjects: Cavopulmonary window -- Pre-tricuspid shunt -- Transesophageal echocardiography -- Retrograde pulmonary venous flow; Cardiology -- Periodicals; Cardiovascular Diseases -- Case Reports; Cardiovascular Diseases -- Periodicals; Cardiology -- Case Reports; Cardiology -- Periodicals; Cardiology; Electronic journals; Periodicals; 616.12
• DOI: 10.1016/j.jccase.2020.01.004
• Languages: English
• ISSNs: 1878-5409

Abstract

Abstract: A 75-year-old male suffered from dyspnea on exertion. In a referring hospital, cardiac catheterization demonstrated a 25% increase in oxygen saturation between the high superior vena cava (SVC) and the right atrium, suggesting a pre-tricuspid left-to-right shunt. However, neither an intracardiac shunt nor a partial anomalous pulmonary venous connection was detected. Therefore, he was referred to our hospital for further evaluation. A transesophageal echocardiogram revealed a retrograde-dominant bidirectional flow in the right upper pulmonary vein (RUPV). A contrast agent injected via the left upper limb appeared in the SVC and thereafter some contrast entered into the RUPV. A three-dimensional reconstructed computed tomography showed a side-to-side communication between the RUPV and the SVC. A cavopulmonary window was definitively diagnosed, in which the RUPV not only drained into the left atrium but also connected to the SVC side-to-side. <Learning objective: In a suspected case of a pre-tricuspid left-to-right shunt without atrial septal defect and anomalous pulmonary venous connection, a cavopulmonary window would be another differential diagnosis. This rare cardiac anomaly should be taken into consideration in diagnosing a pre-tricuspid left-to-right shunt. Identifying the direction of pulmonary venous flow can be an opportunity to find it.>