Matos Rojas Irma,  Ugas Carlos,  Megue Huamani Marlin,  Katekaru Tokeshi Doris,  Lazarte Claudia,  Valdez Quintana Melissa,  Alpaca Rodriguez Larry,  Casamayor Alvina

Final Pr. ID: Poster #: EDU-08 (R)

The purpose of this exhibit is to review imagings findings of anomalous pulmonary venous return on angiotomography and describe anomalies associated.

Magnetic resonance (MR) imaging and computed tomography (CT) are used in diagnostic and follow – up the congenital vein anomalies. CT provides superior spatial resolution and short time but there is exposure to ionizing radiation. However in many hospital there are only the possibility of obtain CT imaging in neonates and infant.
The total anomalous pulmonary venous return (TAPVR) is the result of failure of the common pulmonary vein to connect to the left atrium with persistence of the primitive splanchnic connections of the pulmonary veins. There are four categories: supracardiac, cardiac, infracardiac and mixed.
The partial anomalous pulmonary venous return (PAPVR) occurs when some but not all segments of the developing lung failed to establish connections with the common pulmonary vein. Read More

Authors:  Matos Rojas Irma , Ugas Carlos , Megue Huamani Marlin , Katekaru Tokeshi Doris , Lazarte Claudia , Valdez Quintana Melissa , Alpaca Rodriguez Larry , Casamayor Alvina

Keywords:  anomalous pulmonary venous return, pulmonary veins, CT Scan

Woon Tian Kai,  Fuad Alkhatib Rugaiyah,  Fortier Marielle

Final Pr. ID: Poster #: EDU-011

Partial anomalous pulmonary venous return (PAPVR) consists of a wide spectrum of uncommon congenital anomalies in which one or more pulmonary veins drain directly or indirectly into the right atrium as a result of abnormalities during pulmonary venous embryogenesis. Thus, keen understanding of the underlying embryological origins of the pulmonary venous system is essential to recognize the variations in PAPVR, and radiological assessment is imperative to elucidate the complex anomalous cardiovascular anatomy for subsequent clinical and surgical management. The purpose of this educational exhibit is to provide a brief discussion of the embryological development of pulmonary veins and a detailed review of the diverse array of PAPVR variations with the aid of various case studies and CT imaging findings including sinus venosus atrial septal defect, Scimitar syndrome and anomalous left pulmonary veins. Read More

Authors:  Woon Tian Kai , Fuad Alkhatib Rugaiyah , Fortier Marielle

Keywords:  PAPVR, Partial anomalous pulmonary venous return, Embryology

Fuentealba Cargill Andrea,  Friesen Richard,  Barker Alex,  Fujiwara Takashi,  Englund Erin,  Park Sungho,  Londono Obregon Camila,  Browne Lorna

Final Pr. ID: Poster #: CR-012

A 22-year-old G2P1 female presented to our institution at 22 weeks for fetal cardiology evaluation of hypoplastic left heart syndrome (HLHS) with mitral stenosis and aortic atresia. Fetal echocardiogram confirmed the diagnosis and suggested a severely restricted atrial septum with a pulmonary venous forward/reverse time-velocity integral ratio (VTI) of 2.7.
At 29 weeks' gestation, she underwent a fetal CMR to evaluate for pulmonary lymphangiectasia and interatrial septum.
Fetal cardiac gating was obtained with an MR-compatible Doppler ultrasound device (Smartsync, Northh Medical) and imaging was performed at 3T.
In addition to the findings of HLHS, findings at fetal CMR included an intact/severely restrictive atrial septum with markedly dilated pulmonary veins. Additionally, there was an anomalous pulmonary vein connecting the right sided pulmonary veins to both the azygos vein and the SVC. 4D flow MRI quantified the distribution of blood flow, demonstrated a similar pulmonary venous forward/reverse flow ratio of 2.4 and visualized the anomalous vessel decompressing the pulmonary venous system into the systemic venous system. There was a segmental pattern of pulmonary lymphangiectasia, present in the right middle lobe and lingula.
Same day fetal echocardiography also confirmed the anatomical findings. The patient was determined not to be a candidate for fetal intervention and following counselling, the family elected for comfort care at delivery. After delivery, the baby did not demonstrate clinical signs of a restrictive atrial septum, despite an atrial septal gradient of 11mmHg by echocardiography, and following re-evaluation, underwent a staged single ventricle palliation. At surgery for stage 1 (Norwood-Sano), the atrial septum was found to be almost intact. The infant continues to do well and currently is status post stage 2 with a superior cavopulmonary anastomosis.
This case demonstrates the use of fetal CMR with an MR compatible doppler ultrasound device in the fetal evaluation of HLHS with a suspected restrictive atrial septum. In this case, fetal CMR with 4D flow was able to calculate a pulmonary venous forward/reverse flow ratio similar to echocardiography and demonstrated the anomalous pulmonary venous drainage pathway, which likely accounted for the absence of the expected severe manifestations of an intact atrial septum in addition to the relatively mild manifestations of pulmonary lymphangiectasia. Read More

Authors:  Fuentealba Cargill Andrea , Friesen Richard , Barker Alex , Fujiwara Takashi , Englund Erin , Park Sungho , Londono Obregon Camila , Browne Lorna

Keywords:  4D Flow, Pulmonary Venous Return, Cardiac MRI