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Pulmonary resection and contralateral anomalous venous drainage: a lethal combination
M D Black1, F M Shamji, W Goldstein
1Department of Thoracic Surgery, Ottawa Civic Hospital, Ontario, Canada.
The Annals of Thoracic Surgery
|April 1, 1992
Summary
A patient developed acute right heart failure after lung cancer surgery. This was caused by an undiagnosed partial anomalous pulmonary venous drainage, creating a left-to-right shunt.
Area of Science:
- Cardiology
- Thoracic Surgery
- Medical Imaging
Background:
- A 72-year-old woman underwent a right intrapericardial pneumonectomy for primary lung cancer.
- The patient was acyanotic prior to the procedure.
Observation:
- Two hours post-surgery, the patient developed acute right heart failure and systemic hypotension.
- This clinical presentation suggested a significant hemodynamic complication.
Findings:
- A postoperative pulmonary angiogram was performed to investigate the cause.
- The angiogram revealed a major left-to-right shunt.
- The shunt was attributed to previously unsuspected partial anomalous pulmonary venous drainage (PAPVD) of the left upper lobe.
Implications:
- Undiagnosed PAPVD can lead to severe postoperative complications after thoracic surgery.
- Early diagnosis and management of anomalous venous connections are crucial in cardiothoracic procedures.
- This case highlights the importance of considering congenital anomalies in the differential diagnosis of postoperative heart failure.