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Anomalous pulmonary venous drainage total & partial CT role

Anomalous Pulmonary Venous Drainage TOTAL & PARTIAL
CT role

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Anomalous pulmonary venous drainage total & partial CT role

  1. 1. APVD T&P BY M.GIBREEL, FEBR Cardiac Imaging Senior Registrar NHI&AHC
  2. 2. TAPVD  DEF: No direct communication between the pulmonary veins and the LA. Instead, they drain anomalously into the systemic venous tributaries or into the RA .  Types: 1)Supracardiac: 50% of TAPVR patients. The common pulmonary venous sinus (posterior chamber) drains into the right SVC through the left vertical vein and the left innominate vein. 2)Cardiac: 20% of TAPVR patients. The pulmonary veins enter the RA separately through four openings or the common pulmonary venous sinus drains into the coronary sinus. 3)Infracardiac: 20% of TAPVR patients. The common pulmonary venous sinus drains to the portal vein, hepatic vein, or IVC. The common pulmonary vein penetrates the diaphragm through the esophageal hiatus. 4)Mixed type: combination of the other types, 10% of TAPVR patients.
  3. 3.  Marked cyanosis and respiratory distress develop in the neonatal period with failure to thrive.  Cyanosis worsens with feeding, especially in infants with the infracardiac type, resulting from compression of the common pulmonary vein by the food filled esophagus.
  4. 4. Features Common to All Types:  A large RV with a compressed LV (i.e., relative hypoplasia of the LV) A RA and a small LA, dilated Pas.  An interatrial communication is usually present. PFO occurs in 70% of patients, and secundum ASD occurs in 30%. RESTRICTIVE OR NOT BY ECHO ,,, CT >> Size otherwise Rashkind procedure.  A large common chamber .
  5. 5.  Without surgical repair, two thirds of the infants without obstruction die before reaching 1 year of age. They usually die from superimposed pneumonia.  Patients with the infracardiac type rarely survive for longer than a few weeks without surgery. Most die before 2 months of age.
  6. 6. CT role  Confirm the diagnosis ,,,,, Anatomy .  Exclude obstruction of the vertical /descending vein.  Size of ASD is it adequate for mixing or not .  Describe the course of the vertical vein ,,,, (not intra-parenchymal).
  7. 7. SURGERY  Supracardiac type,,, large, side-to-side anastomosis is made between the common pulmonary venous sinus and the LA. The vertical vein is ligated. The ASD is closed.
  8. 8.  TAPVR to the RA. The atrial septum is excised, and a patch is sewn in such a way that the pulmonary venous return is diverted to the LA .  TAPVR to the coronary sinus. An incision is made in the anterior wall of the coronary sinus (“unroofing”) to make a communication between the coronary sinus and the LA. Then ASD & the ostium of the coronary sinus are closed by patch.
  9. 9.  Infracardiac type. A large vertical anastomosis is made between the common pulmonary venous sinus and the LA. The common pulmonary vein, which descends vertically to the abdominal cavity, is ligated above the diaphragm.
  10. 10. PAPVD  Definition: One or more (but not all) pulmonary veins drain into the RA or its venous tributaries such as the SVC, IVC, coronary sinus, and left innominate vein. The right pulmonary veins are involved twice as often as the left pulmonary veins.
  11. 11.  The right pulmonary veins may drain into the SVC, often associated with a sinus venosus defect , or drain into the IVC in association with an intact atrial septum and bronchopulmonary sequestration (scimitar syndrome ).  The left pulmonary veins either drain into the left innominate vein or into the coronary sinus . ASD is common.  Hemodynamic alterations are similar to those in ASD. Pulmonary blood flow increases.  The magnitude of the pulmonary recirculation is determined by the number of anomalous pulmonary veins, the presence and size of the ASD, and the PVR.
  12. 12. CT role:  Confirm the diagnosis.  Full assessment of the pulmonary veins (number, drainage of each segment , exclude ostial stenosis)  If u noted four pulmonary veins draining into LA, this doesn't mean normal venous drainage always ,,,,anomalous segmental drainage may be present .  Distance of each draining vein to SVC/RA junction.( what above the level of the RPA /LPA not suitable for repair )
  13. 13. Surgery  In cases of significant left-to-right shunt with a Qp/Qs ratio of greater than 2:1  Scimitar syndrome with severe hypoplasia of the right lung even with a Qp/Qs ratio less than 2:1.  Surgery is carried out between the age of 2 and 5 years.
  14. 14. Another case
  15. 15. Another case (inferior type SVASD)
  16. 16. Unique Cases MY FULL REPORTING
  17. 17. Case 1
  18. 18. Case 2
  19. 19. Thank U GIPRIANO@YAHOO.COM

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Anomalous Pulmonary Venous Drainage TOTAL & PARTIAL CT role


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