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Melovitz-Vasan, C.; White, A.; Huff, S.; Vasan, N.
Folia morphologica, 01/2023, Letnik: 82, Številka: 4Journal Article
Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiovascularcondition in which some of the pulmonary veins drain into the systemiccirculation. We report on the cadaveric dissection of a 71-year-old Caucasian maledonor who died of chronic obstructive pulmonary disease with hypertension. Wenoted a faint incisional scar on the thorax extending from the parasternal regionat the 4th intercostal level to the midaxillary line. Since the straight-line incisionfollowed the ribs and the scar was quite faint, surgery probably occurred whenthe donor was young. We also observed numerous surgical interventions of theheart, lungs, and vasculature to correct various defects.The morphology of the heart was normal, but was shifted more to the rightside. An atrial septal defect (ASD) was closed with sutures. The right superiorpulmonary vein that drained into the superior vena cava (SVC) was ligated closeto the SVC and the right inferior, left superior, and inferior pulmonary veins alldrained directly into the left atrium. We noticed a dilated coronary sinus enteringthe right atrium adjacent to the ASD; the ostium of the coronary sinus noticeablylacked the normal valve-like structure. We initially thought the right lung wasa “horseshoe” lung, but realised that it was a “hypogenetic” lung with PAPVR andan accessory diaphragm. Compared to the left, the right secondary bronchi weremuch narrower and branched uncharacteristically, as seen in hypogenetic lungsyndrome. The inferior lobe was highly disorganised, severely hypoplastic, andexhibited uncharacteristic morphology. The superior bronchopulmonary segmentwas markedly hypoplastic. The posterior and medial basal segments were notonly hypoplastic and slender, but also extended like a tail to the left pulmonarycavity behind the heart/pericardium and in front of the oesophagus and aorta.The right lung, though hypoplastic, demonstrated patent bronchi and the lobeswere inflatable. Based on the hypogenetic lung and PAPVR, we conclude that thedonor exhibited ‘scimitar’ lung.
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