Partial anomalous pulmonary venous connection.

Abstract

perlipidaemic with a positive family history for coronary artery disease (father) and diabetes mellitus (mother) was investigated for chest pain. The clinical examination gave no clear pathological findings. The ECG was normal. Blood biochemistry confirmed the reported hyperlipidaemia. The transthoracic echocardiogram showed a small dilatation of the right cardiac cavities. There was no atrial or ventricular septal defect, nor any other anatomical myocardial anomaly. A stress test was negative for myocardial ischaemia. On cardiac catheterisation a left-toright shunt of 14% of the systemic circulation was calculated from oximetry. Coronary angiography showed coronary vessels without haemodynamically significant lesions. A transoesophageal echocardiographic study failed to record the outflow of all pulmonary veins in the left atrium. Magnetic resonance angiography (Siemens Magnetom Symphony, Siemens Medical Solutions, Erlangen, DE) depicted an ectopic vessel adjacent to the aortic arch, connecting the left superior pulmonary vein with the ipsilateral left brachiocephalic vein (Figure 1). This congenital type of shunt drains the blood from the left