Partial Anomalous Pulmonary Venous Connection: A Benign Cause of Oxygen-Rich Central Venous Blood

First Author(s)

• 

  Charles Kreisel, MD

  MedStar Georgetown Universary Hospital

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• LO

  Lindsey Orr

  Pulmonary and Critical Care Fellow
  MedStar Georgetown University Hospital, United States

  Disclosure information not submitted.
• RM

  Rabia Mirza

  Resident Physician
  MedStar Georgetown University Hospital, United States

  Disclosure information not submitted.
• IO

  Ian Oppenheim, n/a

  Attending Physician
  MedStar Georgetown University Hospital, United States

  Disclosure information not submitted.

Title: Partial Anomalous Pulmonary Venous Connection: A Benign Cause of Oxygen Rich Central Venous Blood

Introduction:  Partial anomalous pulmonary venous connections (PAPVC) are not uncommon and occur at a rate of nearly 1:1,000 people. While total anomalous pulmonary venous return often presents as a cyanotic congenital heart disease requiring immediate intervention at birth, PAPVC is often asymptomatic and goes unrecognized. When PAPVC occurs, blood cannulated from the admixed vessel appears to be low pressure on waveform transduction but with high oxygen saturations typically indicative of an arterial cannulation. We present a case of PAPVC inadvertently identified upon right internal jugular central venous catheterization.

Description:  Our patient is a 66 year old woman with no history of congenital heart disease who presented as a transfer from an outside hospital for management of undifferentiated shock and acute hypoxic respiratory failure. Upon arrival, she abruptly entered cardiac arrest and was resuscitated after two minutes. We then placed a right femoral arterial catheter and a right internal jugular central venous catheter (CVC) to deliver vasopressors. Due to the unclear etiology of shock, we obtained a central venous blood gas which measured an oxygen saturation of 96.2%. Due to the concern for arterial misplacement of the CVC, we immediately placed an alternative CVC in the right subclavian vein. We then performed waveform pressure transduction on the initial CVC which did not demonstrate a waveform. Computed tomography angiography (CTA) eventually identified placement of the original CVC in the right brachiocephalic vein with an anomalous pulmonary vein draining from the left superior pulmonary vein into the left brachiocephalic vein.