Key result
Isolated right vs. left upper PAPVC is linked to higher shunt ratios, averaging ~1.7 vs. 1.4.
Why the study?
The role of echocardiography in diagnosing isolated and atrial septal defect (ASD)-associated partial anomalous pulmonary venous connections (PAPVC) and guiding clinical management in children needed evaluation.
Does transthoracic echocardiography accurately characterize anatomical subtypes and hemodynamic severity (Qp/Qs and RV volume) to guide management in children with isolated and ASD-associated partial anomalous pulmonary venous connections?
Cohort (n=208)
No
Does transthoracic echocardiography accurately characterize anatomical subtypes and hemodynamic severity (Qp/Qs and RV volume) to guide management in children with isolated and ASD-associated partial anomalous pulmonary venous connections?
Echocardiography reliably quantifies shunt volume and right ventricular dilation in pediatric PAPVC, demonstrating that even isolated single-vessel anomalies (especially of the right upper pulmonary vein) frequently cause significant shunting (Qp/Qs >= 1.5) warranting surgical repair rather than conservative observation.
Right upper anomalies may warrant closer shunt surveillance in isolated PAPVC; extends subtype hemodynamics but leaves management thresholds hypothesis-generating.
Purpose This study aims to evaluate the role of echocardiography in diagnosing isolated and atrial septal defect (ASD)-associated partial anomalous pulmonary venous connections (PAPVC) and in guiding their clinical management. Methods A retrospective analysis was performed utilizing an echocardiographic database spanning from 2010 to 2025. Cases of isolated or ASD-associated PAPVC confirmed through surgical intervention or computed tomography angiography (CTA) were selected. Echocardiographic parameters were analyzed, and intergroup differences were assessed using univariate analysis of variance (ANOVA) and the Mann-Whitney U test. Additionally, multivariate linear regression analysis was conducted to evaluate the impact of age and sex on right ventricular parameters. Results A total of 208 patients were included in the study, with a median age of 3 years (range 0.1–13 years). Among these patients, 69 cases presented with isolated PAPVC, while 139 cases were associated with ASD. Among the single-vessel anomalies, the abnormal connection of the right upper pulmonary vein was the most prevalent, occurring in 48.1% (100/208) of cases. The Qp/Qs ratio was significantly higher in the group with isolated right upper pulmonary vein anomalies compared to those with isolated left upper pulmonary vein anomalies (1.7 vs. 1.4; P = 0.004). Additionally, the right ventricular end-diastolic volume was greater in the former group (96 [37, 211] vs. 91 [35, 209] mL/m², P <0.0.5). Furthermore, ASD-associated PAPVC is more complex than isolated PAPVC and is at a higher risk of being overlooked. Conclusion This study presents the echocardiographic and hemodynamic characteristics of isolated and ASD-associated PAPVC. PAPVC can lead to substantial left-to-right shunting, with a Qp/Qs ratio exceeding 1.5. Furthermore, ASD-associated PAPVC exhibits greater complexity than isolated PAPVC and is more likely to be overlooked.
No takes yet. Share an insight, caveat, or question.
Yuan et al. (2026) conducted a cohort in Isolated and atrial septal defect (ASD)-associated partial anomalous pulmonary venous connections (PAPVC) in children (n=208). Isolated right upper pulmonary vein anomaly assessed by transthoracic echocardiography vs. Isolated left upper pulmonary vein anomaly was evaluated on Pulmonary-to-systemic blood flow ratio (Qp/Qs) (p=0.004). Isolated right upper pulmonary vein anomalies resulted in a significantly higher Qp/Qs ratio than isolated left upper pulmonary vein anomalies (1.7 vs. 1.4; P=0.004) in children with PAPVC.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: