J Thorac Cardiovasc Surg 2007;134:496-501
© 2007 The American Association for Thoracic Surgery
Clinical-Pathologic Conference in Surgery for Congenital and Acquired Cardiovascular Disease: Unilateral pulmonary vein stenosis with a contralateral pulmonary varix
Yvonne L. Douglas, MDa,*,
Stan A.J. van den Broek, MD, PhDa,
Peter J. Wijkstra, MD, PhDa,
Rienhart F.E. Wolf, MD, PhDa,
Wim Timens, MD, PhDa,
Marco C. DeRuiter, PhDb,
Tjark Ebels, MD, PhDa
a University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
b Leiden University Medical Center, Leiden, The Netherlands.
Received for publication February 4, 2007; revisions received March 15, 2007; accepted for publication March 20, 2007.
* Address for reprints: Y. L. Douglas, MD, Department of Cardio-thoracic Surgery, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, The Netherlands. (Email: Y.L.Douglas@thorax.umcg.nl).
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Case Presentation
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Dr Douglas
A 41-year-old woman was admitted to our medical center by the pulmonologist in July 2004 because of progressive dyspnea on exertion. There was no remarkable medical history except for mild dyspnea existing from about 1996. Physical examination revealed no dyspnea at rest, with normal breath sounds. There were no signs of cyanosis. Laboratory data demonstrated a normal hematologic profile, and there was no serologic evidence of a systemic disease. The chest film showed bilateral interstitial abnormalities and a blurred left hemidiaphragm (Figure 1).
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Figure 1. Chest film showing bilateral interstitial abnormalities and a left-sided, blurry vascular structure above the diaphragm.
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Dr Wijkstra, could you describe the bronchoscopic examination and the pulmonary function test?
Dr Wijkstra
Bronchoscopic findings were within normal limits. Pulmonary function tests showed mild bronchial obstruction with normal static volumes (Table 1). We also performed ventilation–perfusion lung scintigraphy, which revealed nearly symmetrical ventilation (right 58%, left 42%) but very asymmetrical perfusion to the detriment of the left lung (right 87%, left 13%) (Figure 2, A and B).
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TABLE 1 Preoperative and postoperative pulmonary function
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Figure 2. Ventilation (A) and perfusion (B) lung scintiscans showing symmetrical ventilation (right 58%, left 42%) but asymmetrical perfusion to the detriment of the left lung (right 83%, left 17%). RPO, Right posterior oblique; LPO, left posterior oblique.
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Dr Douglas
Dr van den Broek, could you describe what the cardiologic examination revealed?
Dr van den Broek
Cardiac auscultation was completely normal. The electrocardiogram showed signs of right ventricular overload, and transesophageal echocardiography showed turbulent flow at the level of the right pulmonary veins (PVs), together with mild mitral valve regurgitation. Cardiac catheterization showed pulmonary arterial hypertension (40/15–28 mm Hg), discrepant high left pulmonary artery wedge pressure (30 mm Hg) compared with the left ventricular end-diastolic pressure (14 mm Hg), together with a high pulmonary vascular resistance (PVR): . . . [Full Text of this Article]
Copyright © 2007 by The American Association for Thoracic Surgery.
