Isolated partial anomalous pulmonary venous return with severe mitral stenosis managed successfully by a modified Warden procedure and mitral valve replacement: a rare case report.

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Isolated partial anomalous pulmonary venous return (PAPVR) without ASD and severe recurrent rheumatic mitral stenosis (n=1). Intervention: Modified Warden procedure and mechanical mitral valve replacement (27 mm bileaflet valve). Primary outcome: Clinical functional status (NYHA class), echocardiographic hemodynamics, and prosthetic function at 12 months.

Q: What does this research mean for the field?

A combined modified Warden procedure and mechanical mitral valve replacement successfully treats coexisting isolated partial anomalous pulmonary venous return and severe rheumatic mitral stenosis, improving functional status to NYHA Class I and significantly reducing pulmonary artery pressure at 12 months. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Syeda Aiman Rizvi; Sundia Siddique; Hina Aslam; Muhammad Hassaan Javaid; Hasibullah Aminpoor; Hasiba Karimi

doi:10.1097/rc9.0000000000001093

November 1, 2026

Isolated partial anomalous pulmonary venous return with severe mitral stenosis managed successfully by a modified Warden procedure and mitral valve replacement: a rare case report.

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Key result

Modified Warden procedure with mechanical MVR resolves severe heart failure and cuts sPAP by ~27 mmHg.

n=1

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Why the study?

Partial anomalous pulmonary venous return is very rare, with an incidence of 0.4% to 0.7% in autopsy series, and isolated cases account for less than 10% of all cases.

Key Points

To describe the surgical management and hemodynamic outcomes of a rare co-occurrence of isolated partial anomalous pulmonary venous return and severe rheumatic mitral stenosis.
Diagnostic multimodality imaging, including echocardiography, contrast-enhanced CT, and cardiac catheterization, was performed on a 40-year-old female presenting with NYHA class IV symptoms.
The patient was treated surgically using a modified Warden procedure to reroute anomalous venous drainage to the superior vena cava alongside mechanical mitral valve replacement with a 27 mm bileaflet valve.
At 12-month follow-up, the patient improved to NYHA Class I, with systolic pulmonary artery pressure decreasing from 65 mmHg to 38 mmHg and left atrial volume index decreasing from 86 to 58 mL/m2.
Postoperative echocardiography revealed a functioning mitral prosthesis with a mean gradient of 4 mmHg, normal right ventricular size, TAPSE of 22 mm, and LVEF of 62%, with no arrhythmias, SVC obstruction, or prosthetic dysfunction.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

P

Population

1 female patient (aged 40) with isolated partial anomalous pulmonary venous return without atrial septal defect and severe recurrent rheumatic mitral stenosis post-PTMC, presenting in NYHA class IV, followed for 12 months.

I

Intervention

Combined modified Warden procedure (redirection of anomalous right upper pulmonary vein flow to the left atrium via a pericardial baffle through an iatrogenic ASD and anastomosis of the distal SVC to the right atrial appendage) and mechanical mitral valve replacement using a 27 mm bileaflet valve prosthesis, followed by warfarin (target INR 2.5–3.5) and aspirin 100 mg daily.

O

Outcome

Clinical status (NYHA functional class), echocardiographic hemodynamics (SPAP, LVEF, LAVI, right ventricular size, prosthetic mean gradient), and procedural complications at 12 months follow-up.hard clinical

Limitations

Uncontrolled single-case study
Follow-up period of 12 months is inadequate to evaluate long-term durability of the prosthesis or assess pulmonary vascular remodeling
Absence of cardiac magnetic resonance imaging precluded accurate estimation of right ventricular volumes
Follow-up period of 12 months is inadequate to evaluate the long-term durability of the prosthesis or to assess pulmonary vascular remodeling
The absence of cardiac magnetic resonance imaging precluded accurate estimation of right ventricular volumes

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Implication

Demonstrates that the rare coexistence of isolated supracardiac PAPVR without ASD and severe rheumatic mitral stenosis can be safely and effectively treated via a combined modified Warden procedure and mechanical mitral valve replacement.

Abstract

Background: Partial anomalous pulmonary venous return (PAPVR) is a very rare condition, with an incidence ranging from 0.4% to 0.7% in autopsy series. Isolated PAPVR without autism spectrum disorder is extremely rare, accounting for less than 10% of all PAPVR. Case presentation: ; a Wilkins score of 9/16). She underwent a modified Warden procedure and mechanical mitral valve replacement using a 27 mm bileaflet valve. The postoperative course was uneventful. After 12 months, she improved to NYHA Class I, with a prosthetic mean gradient of 4 mmHg, a normal right ventricular size, and a low systolic pulmonary artery pressure (38 mmHg). No arrhythmias, SVC obstruction, or prosthetic dysfunction were noted. Conclusion: This is an example of the complicated hemodynamic relationship between PAPVR and severe rheumatic mitral stenosis. The two conditions can be repaired together successfully with careful multimodality imaging assessment and an individualized surgical plan.

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Cite This Study

Rizvi et al. (2026) conducted a case report in Isolated partial anomalous pulmonary venous return (PAPVR) without ASD and severe recurrent rheumatic mitral stenosis (n=1). Modified Warden procedure and mechanical mitral valve replacement (27 mm bileaflet valve) was evaluated on Clinical functional status (NYHA class), echocardiographic hemodynamics, and prosthetic function at 12 months. Combined modified Warden procedure and mechanical mitral valve replacement improved functional status from functional class IV to I and reduced systolic pulmonary artery pressure from 65 to 38 mmHg at 12 months.

synapsesocial.com/papers/6af46da27bb3da179b8501ee https://doi.org/10.1097/rc9.0000000000001093

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Isolated partial anomalous pulmonary venous return with severe mitral stenosis managed successfully by a modified Warden procedure and mitral valve replacement: a rare case report.

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Isolated partial anomalous pulmonary venous return with severe mitral stenosis managed successfully by a modified Warden procedure and mitral valve replacement: a rare case report.

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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