Unmasking a Missed Left-sided Partial Anomalous Pulmonary Venous Return and Residual Atrial Septal Defect a Decade after Device Closure: Integrated Surgical Repair with Coronary Bypass

We report a rare case of residual atrial septal defect (ASD) and left-sided partial anomalous pulmonary venous return (PAPVR) diagnosed a decade after transcatheter ASD closure. The patient also had significant left anterior descending artery stenosis. Comprehensive imaging revealed previously unrecognized anomalies, and the patient underwent successful single-stage surgical correction involving PAPVR rerouting, ASD closure, and coronary artery bypass grafting. This case underscores the limitations of standard imaging in detecting extracardiac anomalies and highlights the importance of thorough preprocedural evaluation. Integrated surgical intervention proved safe and effective in managing coexisting congenital and acquired cardiac conditions.