Partial Anomalous Pulmonary Venous Return in Adults: Beyond Anatomy: A Cardiologist's Guide

Partial anomalous pulmonary venous return (PAPVR) is a congenital cardiovascular malformation in which one or more pulmonary veins drain abnormally into the right atrium or systemic venous circulation, producing a pretricuspid left-to-right shunt. In anatomic terms, this condition is more precisely described as a partial anomalous pulmonary venous connection, whereas PAPVR refers to the physiological consequence of anomalous venous drainage. Historically, these anomalies were most often diagnosed during childhood; however, with increasing use of cross-sectional imaging modalities such as cardiac computed tomography and cardiovascular magnetic resonance, the condition is increasingly identified in adults. Adult presentations are heterogeneous, ranging from incidental imaging findings to clinically significant disease characterized by right ventricular volume overload, atrial arrhythmias, and pulmonary arterial hypertension. Recognition of PAPVR/partial anomalous pulmonary venous connection in adults remains clinically important, as delayed diagnosis may allow progressive right-sided cardiac remodeling and pulmonary vascular changes. This narrative review aims to move beyond classic anatomical descriptions and provide a clinically oriented overview of PAPVR in adults. We summarize the embryologic basis, anatomic variants, epidemiology, clinical manifestations, and hemodynamic consequences of this condition. Particular emphasis is placed on multimodality imaging-including transthoracic echocardiography, cardiac computed tomography, and cardiovascular magnetic resonance-for accurate diagnosis and procedural planning. The review also discusses hemodynamic evaluation with right-heart catheterization, risk assessment for pulmonary hypertension, and indications for intervention. Management strategies are reviewed in detail, including surgical techniques such as intracardiac baffling, single-patch and 2-patch repairs, and the Warden procedure, as well as the evolving role of transcatheter and hybrid approaches in carefully selected adult patients. Special clinical scenarios-including late presentation, pregnancy, and coexisting pulmonary hypertension-are also addressed. By integrating diagnostic, therapeutic, and longitudinal follow-up perspectives, this review provides a practical framework for the evaluation and management of adults with PAPVR in modern cardiology practice.