Three-Dimensional-Enabled Surgical Planning for the Correction of Right Partial Anomalous Pulmonary Venous Return

Figures

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  Figure 1. Flowchart showing the inclusion and exclusion criteria during the selection of the study population. CT: computed tomography; IVC: inferior vena cava; MRI: magnetic resonance imaging; PAPVR: partial anomalous pulmonary venous return; RAMT: right anterior minithoracotomy; SVC: superior vena cava.

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  Figure 2. Three-dimensional reconstruction of two cases of partial anomalous pulmonary venous return in superior vena cava; the red arrow indicates the azygos vein. (A,A1) Case 1. (A) The anomalous pulmonary veins are displaced closer to the atrio-caval junction; (A1) coronal section; the sinus venosus defect is indicated by the white triangle. (B,B1) Case 2. (B) The most cranial anomalous pulmonary vein drains together with the azygos vein; (B1) coronal section; the sinus venosus defect is indicated by the white triangle. Ao: aorta; PA: pulmonary artery; RA: right atrium; RV: Right Ventricle; *: anomalous pulmonary veins; **: superior vena cava.

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  Figure 3. Determination of the PAPVR ratio. (A) The calculated formula suggests a double patch repair; and (B) the calculated formula suggests a Warden procedure. *: anomalous pulmonary veins; red arrow indicating the azygos vein.

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  Figure 4. ROC curve of PAPVR ratio values in our population.

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  Figure 5. The 3D-printed model of a partial anomalous venous return (highlighted by black and white asterisks) corrected using the Warden technique. (A) An atriotomy is first performed as shown by the black line in the model; (B) the superior sinus venosus defect is now visible (highlighted by the red dotted circle); (C) A patch (yellow arrow) is sutured to baffle the pulmonary veins’ drainage through the sinus venosus defect and into the left atrium; (D) the right atriotomy is closed by direct suture; (E) the superior vena cava is resected just above the ostium of the most cranial pulmonary vein and a patch is used to close the proximal end of the vena cava itself; the azygos vein (red arrow) is also ligated (not shown in the image); (F) the distal end of the superior vena cava is anastomosed to the right atrium appendage and a patch is used to enlarge the anastomosis to avoid blood flow obstruction. Ao: aorta; IVC: inferior vena cava; PA: pulmonary artery; RA: right atrium; RV: right ventricle; SVC: superior vena cava.

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  Figure 6. The 3D-printed model of a partial anomalous venous return (highlighted by black asterisks) corrected using the double patch technique. (A) An atriotomy is first performed as shown by the black line in the model; (B) the superior sinus venosus defect is now visible (highlighted by the red asterisk) through the superior half pf the right atriotomy (highlighted by the light blue line); (C) the first patch is sutured to baffle the pulmonary veins’ drainage through the sinus venosus defect and into the left atrium; (D) the second patch is used to enlarge the superior vena cava to avoid blood flow obstruction. Ao: aorta; IVC: inferior vena cava; PA: pulmonary artery; RA: right atrium; RV: right ventricle; SVC: superior vena cava.