RT Book, Section
A1 Doherty, Gerard M.
SR Print(0)
ID 1004107134
T1 Pulmonary Venous Connection, Total Anomalous
T2 Quick Answers Surgery
YR 2010
FD 2010
PB The McGraw-Hill Companies
PP New York, NY
SN 
LK accesssurgery.mhmedical.com/content.aspx?aid=1004107134
RD 2024/04/25
AB •  A  congenital  heart  lesion  that  increases  pulmonary  arterial  blood  flow•  Results  in  left-to-right  shunt,  results  in  lung  infection,  pulmonary  vascular  congestion,  pulmonary  artery  (PA)  hypertension,  right  heart  failure,  pulmonary  vasoconstriction,  pulmonary  vascular  obstructive  disease•  Eisenmenger  syndrome:  Increased  pulmonary  hypertension  such  that  left-to-right  shunt  ceases  and  shunt  becomes  right-to-left,  requiring  heart-lung  transplant•  Inhaled  nitric  oxide,  oxygen,  or  IV  tolazoline  reverses  PA  vasoconstriction•  PA  band  is  palliative  and  can  reduce  PA  flow  to  alleviate  RV  failure  and  progression  of  pulmonary  hypertension•  Pulmonary  veins  do  not  make  direct  connection  with  LA,  instead  confluence  connects  to  central  systemic  veins,  draining  into  RA•  Blood  gets  to  LA  atrium  via  atrial  septal  defect  (ASD)  or  patent  ductus  arteriosus  (PDA)•  Similar  oxygen  saturation  in  PA  and  aorta•  3  types  (depends  on  site  of  connection):-Type  I,  Supracardiac:  Left-sided  vertical  vein  drains  into  innominate  vein  (45%)  -Type  II,  cardiac:  Connection  to  RA  or  coronary  sinus  (25%)  -Type  III,  infracardiac:  Connection  to  infradiaphgragmatic  inferior  vena  cava  (IVC)  or  portal  vein  (25%)5%  have  mixed  venous  drainage•  Pulmonary  venous  obstruction  occurs  in  nearly  all  with  infracardiac  connection,  <  25%  with  supracardiac  connection•  Obstruction  leads  to  increased  pulmonary  vascular  resistance•  Associated  anomalies  rare