The pulmonary vein (photo below) is a vessel that brings arterial blood, enriched with oxygen in the lungs, to the left atrium.
Starting from the pulmonary capillaries, these vessels merge into larger veins, which go to the bronchi, then segments, lobes, and at the gates of the lung form large trunks (two from each root), which in a horizontal position go to the upper part left atrium. In this case, each of the trunks penetrates into a separate hole: the left ones - from the left side of the left atrium, and the right ones from the right. The right pulmonary veins, following to the atrium (left), transversely cross the right atrium (its back wall).
Superior pulmonary (right) vein
Formed by segmental veins from segments of the middle and upper lobes of the lung.
- R.apicalis (Apical branch) - represented by a short venous trunk, which is located on the upper lobe (its mediastinal surface) and carries blood from the apex segment. Before entering the right upper pulmonary vein, it often combines with a segmental (posterior) branch.
- R. posterior(Posterior branch) collects blood from the posterior segment. This branch is the largest of all veins (segmental) located in the upper lobe. Several parts are distinguished in this vessel: an intrasegmental segment and a sublobar segment, which collects blood from the interlobar surface in the region of the oblique fissure.
- R.anterior (Anterior branch) collects blood from the upper lobe (its anterior segment). In some cases, it is possible to combine the back and front branches (then they flow into a common trunk).
- R.lobi medii (middle lobe branch) receives blood from segments of the right lung (its middle lobe). In some cases, this vein takes the form of a single trunk and flows into the upper right pulmonary vein, but more often the vessel is formed from two parts: medial and lateral, which drain the medial and lateral segments, respectively.
Inferior pulmonary (right) vein
This vessel receives blood from the lower lobe (its 5 segments) and has two main tributaries: the basal common vein and the superior branch.
Top branch
Lays between the basal and upper segments. It is formed from the accessory and main veins, follows forward and downward, passing behind the segmental apical bronchus. This branch is the highest of all that flow into the lower right pulmonary vein.
According to the bronchus, the main vein contains three tributaries: lateral, superior, medial, located mostly intersegmentally, but can also lie intrasegmentally.
Thanks to the accessory vein, blood is drained from the upper segment (its upper part) into the sublobar region of the segmental posterior vein of the upper lobe (its posterior segment).
Basal common vein
It is a short venous trunk formed by the confluence of the inferior and superior basal veins, the main branches of which lie much deeper than the anterior lobar surface.
Basal superior vein. Formed by the fusion of the largest of the basal segmental veins, as well as veins that carry blood from the medial, anterior and lateral segments.
Basal inferior vein. Adjacent to the basal common vein from the side of its posterior surface. The main tributary of this vessel is the basal posterior branch, which collects blood from the basal posterior segment. In some cases, the basal inferior vein may approach the basal superior vein.
ADLV
It is a congenital pathology of the heart, in which a non-anatomical entry of the pulmonary veins into the atrium (right) or into the last vena cava is detected.
This pathology is accompanied by frequent pneumonia, fatigue, shortness of breath, physical development lag, heart pain. As a diagnosis, they use: ECG, MRI, radiography, cardiac sounding, ultrasound, ventriculo- and atriography, angiopulmonography.
Surgical treatment of the defect depends on its type.
General information
ADLV is a congenital defect and accounts for about 1.5-3.0% of heart defects. Mostits observed in male patients.
Most often this defect is combined with an oval (open) window and septal defects between the ventricles. A little less often (20%) - with an arterial common trunk, hypoplasia of the left side of the heart, VSD, dextrocardia, Fallot's tetrad and transpositions of the main vessels, a common ventricle of the heart.
In addition to the above malformations, ADLV is often accompanied by extracardiac pathology: umbilical hernias, malformations of the endocrine and bone systems, intestinal diverticula, horseshoe kidney, hydronephrosis and polycystic kidney disease.
Classification of anomalous pulmonary venous drainage (APLV)
If all veins flow into the systemic circulation or into the right atrium, this defect is called complete anomalous drainage, if one or more veins flow into the above structures, then this defect is called partial.
According to the level of confluence, several variants of vice are distinguished:
- Option one: supracardial (supracardial). The pulmonary veins (as a common trunk or separately) flow into the superior vena cava or its branches.
- Second option: cardiac (intracardiac). Pulmonary veins are drained into the coronary sinus or right atrium.
- Third option: subcardiac (infra- or subcardial). The pulmonary veins enter the portal or inferior vena cava (much less often the lymphatic duct).
- Fourth option: mixed. The pulmonary veins enter different structures and at different levels.
Features of hemodynamics
WoIn the intrauterine period, this defect, as a rule, does not manifest itself, due to the peculiarities of the fetal circulation. After the birth of a baby, the manifestations of hemodynamic disorders are determined by the variant of the defect and its combination with other congenital anomalies.
In case of total anomalous drainage, hemodynamic disturbances are expressed by hypoxemia, hyperkinetic overload of the right heart and pulmonary hypertension.
In the case of partial drainage, hemodynamics are similar to those in ASD. The leading role in the disorders belongs to the abnormal venous-arterial shunt of blood, which leads to an increase in blood volume in the small circle.
Symptoms of abnormal pulmonary venous drainage
Children with this defect often suffer from repeated SARS and pneumonia, they have cough, low weight gain, tachycardia, shortness of breath, heart pain, mild cyanosis and fatigue.
In case of apparent pulmonary hypertension at a young age, heart failure, severe cyanosis and a heart hump appear.
Diagnosis
The picture of auscultation in ADLV is similar to ASD, that is, a systolic coarse murmur is heard in the area of projections of the arteries of the veins (pulmonary veins) and splitting of the 2nd tone.
- On the ECG signs of overload of the right heart, EOS deviation to the right, blockade (incomplete) of the right leg of the Hiss bundle.
- With phonography signs of ASD.
- On radiography, the pattern of the lungs is enhanced, the pulmonary artery (its arc) bulges, the expansion of the cardiacsaber" symptom.
- EchoCG.
- Probing of cardiac cavities.
- Plebography.
- Atriography (right).
- Angiopulmonography.
- Ventriculography.
Differential diagnosis of this defect should be carried out with:
- Lymphangiectasia.
- Aortic/mitral valve atresia.
- Transposition of vessels.
- Mitral stenosis.
- Stenosis of the right/left pulmonary veins.
- Three-atrial heart.
- Insulated ASD.
Treatment
Types of surgical treatment of partial drainage are determined by the variant of the defect, the size and location of the ASD.
Interatrial communication is eliminated with the help of plasty or suturing of an ASD. Babies up to three months of age, who are in a critical condition, undergo a palliative operation (closed atrial septotomy), which is aimed at expanding the interatrial communication.
General radical correction of the defect (total form) includes several manipulations.
- Ligation of the pathological communication of vessels with veins.
- Pulmonary vein isolation.
- Closing ASD.
- Formation of an anastomosis between the left atrium and pulmonary veins.
The consequences of such operations can be: an increase in pulmonary hypertension and sinus node insufficiency syndrome.
Forecasts
The prognosis for the natural course of this defect is unfavorable, since 80%patients die within the first year of life.
Patients with partial drainage can live up to the age of thirty. The death of such patients is most often associated with pulmonary infections or severe heart failure.
The results of surgical corrections of the defect are often satisfactory, but among newborns, mortality during or after surgery remains high.
