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Anatomy Atlases: Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins: Head, Neck, and Thorax: Pulmonary Veins

Illustrated Encyclopedia of Human Anatomic Variation: Opus II: Cardiovascular System: Veins: Head, Neck, and Thorax

Pulmonary Veins

Ronald A. Bergman, PhD
Adel K. Afifi, MD, MS
Ryosuke Miyauchi, MD

Peer Review Status: Internally Peer Reviewed


Anomalous connections between the pulmonary and systemic venous system were first recognized by Winslow in 1737. He collected 106 cases (Winslow, J. Mem Acad. Roy. de Sci., p113, 1739).

Parsons, et al., reported 35 cases of anomalous pulmonary drainage without cardiac anomalies. In five cases, the pulmonary vein was connected to the superior vena cava, in five to the right auricle, in five to the left innominate (brachiocephalic) vein, in nine to the coronary sinus, in one to the inferior vena cava, in three to the portal vein, in five to a persistent left superior vena cava, and two to the ductus venosus. The pulmonary veins may also open into the azygos vein.

Pulmonary veins vary in number and size. There are reports of one or more pulmonary veins entering either the right atrium or the inferior or superior vena cava or azygos vein. In one case, a left pulmonary vein opened into the left brachiocephalic vein.

These unusual connections between the pulmonary veins and neighboring, many adversely inappropriate, veins are explicable only on the basis of very early embryonic stages in which the developing foregut, trachea, and lung buds are supplied by a common plexus of small channels that network in all directions through the loose mesenchyme and communicate with the primitive cardinal veins in many places. With the development of certain channels in this primitive vascular bed to form the pulmonary veins leading to the left atrium, the primitive connections with the cardinal veins usually disappear. The unusual development of one or more of them, and its retention by the adult derivative of the particular part of the cardinal system involved, are most probably responsible for the occurrence of these unusual pulmonary connections.

Steinberg and Finby classified the congenital anomalies of the pulmonary circulation as follows

A. Malformations of the Pulmonary Artery.
Primary dilitation (aneurysm)

Requires no treatment.

Valvular stenosis

Requires surgical treatment.

B. Malformation of a Branch of the Pulmonary Artery.
Absence of a main branch pulmonary artery

No treatment required, prognosis good.

Absence of a lung (agenesis)

Compatible with normal life.

C. Pulmonary Arteriovenous fistulas

Requires surgical treatment.

D. Alteration of Pulmonary Circulation.
Patent ductus arteriosus

Reversal of blood flow

Requires surgical treatment.

Anomalous insertions of pulmonary veins.
Partial

May be asymptomatic (with one lung involved). Requires surgical treatment.

Total

Requires surgical treatment.

Anomalous aortic circulation to the lung

May require surgery.

From Steinberg, I. and N. Finby, 1956. See complete reference below.

Keith, et al. reported on 58 cases of anomalous pulmonary drainage as follows;

Cases

Drainage Site

% of Cases

25

Left superior vena cava (or left innominate vein)

43

11

Coronary sinus

19

8

Right auricle

14

7

Right superior vena cava

12

4

Portal vein

6.9

2

Ductus venosus

3.4

0

Inferior vena cava

0

1

Superior vena cava and right auricle

1.7

Anomalous drainage of the pulmonary veins occurs in about 0.7% of individuals (Specht and Brown).


References

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