Partial anomalous pulmonary venous connection with pulmonary hypertension.

Partial anomalous pulmonary venous connection (PAPVC) encompasses a group of cardiovascular anomalies that are caused by the abnormal return of one or more of the pulmonary veins directly to the right atrium or indirectly through a variety of venous connections from the anomalous pulmonary veins.1,2 We present the case of a 51-year-old man, a former smoker, with a history of hypertension, diabetes, dyslipidemia and peripheral artery disease, who reported dyspnea on moderate exertion lasting several months. Laboratory test results (including serologic studies for hepatotropic viruses) were normal. Spirometry tests showed mild obstruction, and plethysmography and diffusing capacity measurements were normal. Chest radiography revealed enlargement of both hila and their vascular markings, with a double density sign on the left paratracheal area (Fig. 1A). The echocardiogram showed: normal left ventricle, right ventricle severely dilated, and indirect signs of pulmonary hypertension (PH). Right heart catheterization showed slight PH (mean PAP 29 mmHg, total PVR 254.84 dyn.s.cm−5). On computed tomography (CT) scan, an anomalous venous structure was seen in which the left pulmonary veins converged, draining into the brachiocephalic vein (Fig. 1B). Based on these findings, the patient underwent surgery (anastomosis of the defective left vein to the left atrium) and was discharged