An Unusual Cause of RV Failure in a Geriatric Patient: Partial Anomalous Pulmonary Venous Drainage

Title : An Unusual Cause of RV Failure in a Geriatric Patient: Partial Anomalous Pulmonary Venous Drainage

Abstract:

Background:

Partial anomalous pulmonary venous drainage (PAPVD) is a rare congenital cardiovascular anomaly causing left-to-right shunting that may result in chronic right ventricular (RV) volume overload and pulmonary hypertension. Although commonly diagnosed in childhood, patients with small asymptomatic shunts may remain undetected until late adulthood.

Case Illustration:

A 69-year-old male presented with progressive exertional dyspnoea for one week and bilateral lower extremity oedema for one month. Physical examination revealed tachypnoea, elevated jugular venous pressure, bilateral coarse crackles, irregular heart rhythm, and bilateral pitting oedema. Electrocardiography demonstrated atrial fibrillation with normoventricular response, right axis deviation, and complete right bundle branch block. Chest radiography showed cardiomegaly with right atrial enlargement, right ventricular hypertrophy, bilateral pulmonary infiltrates, and pleural effusions. Transthoracic echocardiography revealed dilatation of the right atrium and right ventricle with reduced RV systolic function (TAPSE 1.46 cm), moderate tricuspid regurgitation, severe pulmonary hypertension, and coronary sinus dilatation. Left ventricular systolic function was preserved (EF 78%) with concentric remodelling and D-shaped configuration. Contrast echocardiography with bubble test demonstrated coronary sinus dilatation suggestive of persistent left superior vena cava (PLSVC), with microbubble flow entering the right atrium through the coronary sinus and evidence of right-to-left shunting through a suspected superior interatrial septal abnormality.

Conclusion:

PAPVD is a rare and frequently underrecognized congenital anomaly that may remain asymptomatic until late adulthood. Chronic left-to-right shunting can lead to progressive RV volume overload, pulmonary hypertension, right heart dilatation, and eventual RV systolic dysfunction. In geriatric patients, age-related cardiopulmonary decline and associated comorbidities may precipitate acute decompensated right heart failure.

  Keywords: pulmonary venous drainage, pulmonary hypertension, right heart failure

Biography:

Meiza Fadhila Azzahra, MD., is a general practitioner born on May 18, 2000, with a particular interest in cardiovascular medicine and clinical research. She actively participates in scientific meetings and academic activities to expand her knowledge in cardiology. Her professional interests include cardiovascular disease prevention, diagnostic evaluation, and evidence-based patient care. She is committed to continuous learning and future contributions to cardiovascular health services and research.