Total Anomalous Pulmonary Venous Return, Surgically Corrected in Two Patients beyond 40 Years of Age

¹ Departments of Internal Medicine and Pediatrics, University of Virginia Hospital, Charlottesville, Virginia

Two adult patients over 40 years of age with total anomalous pulmonary venous return, which was recognized preoperatively and successfully corrected surgically, are described here. The clinical diagnosis of this condition in adults may not be difficult if it is kept in mind in patients with findings of a large atrial septal defect. The associated cyanosis in a patient with a large atrial septal defect without accompanying, marked elevation of pulmonary vascular resistance or pulmonic stenosis may be a clue to this diagnosis. On cardiac catheterization, the findings of identical O₂ saturations of blood samples from various right and left chambers of the heart, with a slightly higher oxygen saturation in pulmonary artery than the systemic artery are typical features. These were seen in both of our patients. The pulmonary angiogram, of great importance to the surgeon, is essential to delineate the exact anatomy of the anomalous veins. These two cases support previous observations that a favorable prognosis in this condition is associated with a large interatrial communication, a short common pulmonary venous trunk, and a normal pulmonary vascular resistance.