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Three-Dimensional Echocardiographic Method for the Visualization and Assessment of Specific Parameters of the Pulmonary Veins
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A new classification for right top pulmonary vein.

Tadashi Akiba1, Toshiaki Morikawa, Takuya Inagaki

  • 1Department of Surgery, Jikei University Kashiwa Hospital, Chiba, Japan. akiba@jikei.ac.jp

The Annals of Thoracic Surgery
|February 26, 2013
PubMed
Summary

The right top pulmonary vein (PV) is an anomalous branch draining into the left atrium (LA). This study clarifies its definition and classification, proposing a broad term for these venous anomalies.

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Area of Science:

  • Anatomical Variations
  • Thoracic Imaging
  • Cardiovascular Surgery

Background:

  • The "right top pulmonary vein" (PV) is variably defined as an anomalous branch of the right superior PV draining into the left atrium (LA).
  • Existing literature presents diverse terminologies and classifications for PV anomalies.
  • Clarification is needed to standardize the understanding of the right top PV.

Purpose of the Study:

  • To review and consolidate the literature on the right top PV and related anomalies.
  • To analyze the authors' own cases of anomalous PVs using 3D-CT.
  • To propose a standardized definition and classification for the right top PV.

Main Methods:

  • Comprehensive literature review focusing on right top PV, right PV passing behind the intermediate bronchus (BIB), and associated anomalies.
  • Analysis of 303 patients with chest disorders, identifying anomalous PV cases.
  • Detailed review of 9 patients with complete interlobar fissures for lobar drainage patterns.

Main Results:

  • Literature reports a frequency of 0.3% to 9.3% for PV anomalies, with varied terminology.
  • In the authors' cohort, 3.3% of patients exhibited PV anomalies (10/303), with 4 draining directly into the LA and 4 into the right superior PV.
  • Anomalous PVs originated from the right upper or lower lobes; 8 passed the BIB, 1 the main bronchus (BMB), and 1 both.

Conclusions:

  • The term "right top PV" should be broadly defined as an anomalous PV branch draining directly into the LA.
  • A classification system with 6 distinct types is proposed for these anomalies.
  • Standardizing terminology improves diagnostic accuracy and clinical management of PV variations.