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 large trunks form in the gates of the lung (two from each root), which in a horizontal position go to the upper part of the left atrium. In this case, each of the trunks penetrates into a separate hole: the left - on the left side of the left atrium, and the right on the right. The right pulmonary veins, following the atrium (left) crosswise cross the right atrium (its posterior wall).
Superior pulmonary (right) vein
It is formed by segmental veins from segments of the middle and upper lobe of the lung.
- R.apicalis (apical branch) - is represented by a short venous trunk that is located on the upper lobe (its mediastinal surface) and carries blood from the segment of the apex. Before penetrating into the superior pulmonary right vein, it often unites with a segmental (posterior) branch.
- R. posterior (posterior branch) collects blood from the posterior segment. This branch is the largest vein of all veins (segmental) located in the upper lobe. Several parts are distinguished in this vessel: the intrasegmental segment and the sub-lobe segment, which collects blood from the interlobar surface in the region of the oblique gap.
- R.anterior (anterior branch) collects blood from the upper lobe (its anterior segment). In some cases, it is possible to combine the posterior and anterior branches (then they fall into a common trunk).
- R.lobi medii (middle lobe of the 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: the medial and lateral, which drain the medial and lateral segments, respectively.
Lower pulmonary (right) vein
This vessel receives blood from the lower lobe (its 5 segments) and has two main inflows: the common basal vein and the superior branch.
Upper branch
It lies between the basal and upper segments. It is formed from the additional and main veins, it goes forward and down, passing behind the segmental apical bronchus. This branch is the highest of all that flow into the lower right pulmonary vein.
Accordingly, the main vein of the bronchus contains three tributaries: lateral, superior, medial, located mostly intersegmentally, however, they can also run intrasegmentally.
Thanks to the additional vein, blood is drained from the upper segment (its upper part) to the sub-lobe 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 lower and upper basal veins, the main branches of which lie much deeper than the anterior lobar surface.
Basal superior vein. It is formed due to 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 lower surface. The main inflow 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 the vena cava entering the last is revealed.
This pathology is accompanied by frequent pneumonia, fatigue, shortness of breath, physical development retardation, heart pain. Diagnostics used: 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 makes up about 1.5-3.0% of heart defects. Mostly observed in male patients.
Most often, this defect is combined with an oval (open) window and defects of the septum between the ventricles. Slightly less often (20%) - with an arterial common trunk, hypoplasia of the left side of the heart, breast, dextrocardia, tetralogy of Fallot and transpositions of the great vessels, common ventricle of the heart.
In addition to the above defects, 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 Abnormal Pulmonary Drainage (ADLV)
If all veins flow into the pulmonary circulation or into the right atrium, this defect is called complete abnormal drainage, but if one or several veins flow into the above structures, then this defect is called partial.
In accordance with the level of confusion, several types of defect are distinguished:
- Option one: supracardiac (supracardial). Pulmonary veins (as a common trunk or separately) flow into the superior vena cava or its branches.
- Option two: cardiac (intracardial). Pulmonary veins are drained into the coronary sinus or right atrium.
- Option three: subcardiac (infra- or subcardial). Pulmonary veins enter the portal or hollow inferior veins (much less often into the lymphatic duct).
- Fourth option: mixed. Pulmonary veins enter various structures and at different levels.
Hemodynamic features
In the prenatal period, this defect, as a rule, does not appear, due to the peculiarities of the blood circulation of the fetus. After the birth of a baby, the manifestations of hemodynamic disturbances are determined by a variant of the defect and its combination with other congenital anomalies.
In the case of total abnormal drainage, hemodynamic disturbances are expressed by hypoxemia, hyperkinetic overload of the right heart and pulmonary hypertension.
In the case of partial drainage, the hemodynamics are similar to those with ASD. The dominant role in the disorders belongs to abnormal venous-arterial discharge of blood, which leads to an increase in blood volume in a 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 the case of obvious pulmonary hypertension at a young age, heart failure, severe cyanosis and a cardiac hump appear .
Diagnostics
The picture of auscultation with ADLV is similar to ASD, that is, a systolic coarse noise is heard in the area of the projections of the arteries of the veins (pulmonary veins) and splitting of the 2nd tone.
- On the ECG, signs of an overload of the right heart, a deviation of the EOS to the right, blockade of the (incomplete) right leg of the bundle of His.
- With phonography, signs of ASD.
- On radiography, an increase in the pattern of the lungs, bulging of the pulmonary artery (its arc), expansion of the heart borders to the right, "Turkish saber" symptom.
- Echocardiography.
- Sounding of cardiac cavities.
- Phlebography.
- Atriography (right).
- Angiopulmonography.
- Ventriculography.
Differential diagnosis of this defect should be carried out with:
- Lymphangiectasia
- Atresia of the aortic / mitral valves.
- Vascular transposition.
- Mitral stenosis.
- Stenosis of the right / left pulmonary veins.
- Atrial heart.
- Isolated dmpp.
Treatment
The types of surgical treatment for partial drainage are determined by the type of defect, the size and location of the ASD.
Atrial communication is eliminated with the help of plastic or suturing DMPP. Breasts up to three months of age, which are in critical serious condition, undergo palliative surgery (closed atrioseptotomy), which is aimed at expanding the atrial communication.
General radical correction of a defect (total form) involves several manipulations.
- Ligation of the pathological message of vessels with veins.
- Isolation of pulmonary veins.
- The closure of the DTP.
- The formation of an anastomosis between the left atrium and pulmonary veins.
The consequence of such operations may 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% of patients die during 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 correction of the defect are often satisfactory, but among newborns, mortality during or after surgery remains high.