Anomalous left upper pulmonary vein connection with right heart failure following closure of patent foramen ovale

A 68-year-old woman was admitted for rapidly progressive systemic sclerosis. She suffered from exertional dyspnea and decreased exercise tolerance. Pulmonary function testing showed mild restriction with pulmonary fibrosis on high resolution computer tomography (CT). Dilatation of the right ventricle (RV) and right atrium (RA) (fig. 1A) with severe tricuspid regurgitation (TR) was detected by transthoracic echocardiography. Transoesophageal echocardiography was performed in search for intra-cardiac shunts, whereby the right upper