Coexistence of partial anomalous pulmonary venous return and cardiac coronary anomaly – the role of preoperative imaging

Address for correspondence: Mikołaj Frankiewicz MD, University Clinical Centre, 80-214 Gdansk, Poland, phone: +48 58 3493 154, e-mail: [email protected] Received: 12.07.2016, accepted: 14.02.2017. Typical vascular patterns of upper pulmonary lobes are observed in 48% of individuals on the right side and in 46% on the left side [1, 2]. Historically, preoperative imaging of the pulmonary vessels required pulmonary angiography, which was an invasive procedure with limited indications. Nowadays, routine chest computed tomography (CT) provides sufficient imaging of pulmonary arteries and veins. We observed an unusual coincidence of anomalies in pulmonary and coronary vessels in a patient with non-small cell lung cancer (NSCLC). Due to preoperative imaging with CT angiography and classical coronary catheterization it was possible to provide uncomplicated treatment. Anomalous pulmonary venous connections are a specific group of congenital heart defects caused by the abnormal drainage of a part or the entire lung to a systemic vein or the right atrium. The estimated incidence is 2/100 000 births [3]. Prevalence of coronary anomalies is estimated to be 0.2% to 1.3% of patients undergoing coronary angiography [4]. Coexistence of both is very rarely, if ever, described. In most cases (80–90%) partial anomalous pulmonary venous return (PAPVR) is combined with an atrial septal defect [5, 6]. We report a case of anomalous right upper lobe venous drainage to the vena cava superior and to the left atrium with coexisting cardiac coronary anomaly diagnosed in classical coronary catheterization and consisting of the circumflex coronary artery originating from the right rather than the left coronary artery. A 75-year-old man was admitted to the hospital due to a tumor of the right lung confirmed to be NSCLC. The only symptom was a non-productive cough. The lesion was detected during a routine follow-up after nephrectomy due to early papillary renal cell carcinoma 6 years ago. It was a solid focal lesion with slightly irregular borders, measuring 16 × 13 mm. Preoperative evaluation revealed coronary artery disease that required a coronary artery bypass. Preoperative coronary catheterization showed an anomalous right-sided variation of the circumflex coronary artery (Fig. 1 A, Cx). Off pump coronary artery bypass (OPCAB)