Concomitant heart transplantation and repair of left partial anomalous pulmonary venous return (PAPVR) draining into the coronary sinus was successfully performed by unroofing the PAPVR-coronary sinus junction, resecting the septum to form a common chamber, and anastomosing the donor left atrium to this common chamber.
Key Findings
Background
A 64-year-old male with non-ischaemic cardiomyopathy and ventricular septal defect developed cardiogenic shock requiring a surgically implanted microaxial pump prior to heart transplantation listing.
Patient age was 64 years, male sex
Underlying diagnoses included non-ischaemic cardiomyopathy and ventricular septal defect
Cardiogenic shock necessitated insertion of a surgically implanted microaxial pump as a bridge to transplantation
Patient was listed for heart transplantation following hemodynamic deterioration
Background
Preoperative computed tomography identified left PAPVR draining into the coronary sinus, associated with a left superior vena cava and patent innominate vein.
Imaging modality used was computed tomography (CT)
The anomalous vein drained specifically into the coronary sinus, not directly into the right atrium
A persistent left superior vena cava (SVC) was also identified
The innominate vein was patent, indicating venous drainage continuity
Methods
At explant, the left PAPVR was found draining into a dilated coronary sinus that was continuous with the left atrial cuff.
Continuity between the coronary sinus and left atrial cuff was confirmed intraoperatively
This anatomical relationship informed the surgical repair strategy
Methods
The surgical repair involved unroofing the junction of the left PAPVR to the coronary sinus and resecting the septum to create a common chamber incorporating the coronary sinus and left atrial cuff.
The junction of the left PAPVR to the coronary sinus was unroofed
The intervening septum was resected to form a single common chamber
The caudal side of the coronary sinus was closed from both the left atrium and right atrium sides
The donor left atrium was anastomosed to this common chamber using a running 3-0 polypropylene suture
Methods
The persistent left superior vena cava was ligated outside the pericardial space after confirming patency of the innominate vein.
The left SVC was identified in the extrapericardial space
Ligation was performed rather than reimplantation or other reconstruction
Patent innominate vein preoperatively established that ligation would not cause venous outflow obstruction
Ligation was performed as part of the concomitant anomaly repair
Results
The remaining donor heart anastomoses were performed in standard fashion, and the patient was discharged with normal graft function.
All other cardiac anastomoses followed standard orthotopic heart transplantation technique
The patient achieved normal graft function postoperatively
Successful discharge was achieved without reported major complications
This represents a technically feasible approach to managing incidentally discovered PAPVR at the time of heart transplantation
What This Means
This research describes a case report of a 64-year-old man who needed a heart transplant and was also discovered to have a rare heart defect called left partial anomalous pulmonary venous return (PAPVR), where one of the pulmonary veins was draining blood to the wrong location (into the coronary sinus rather than the left atrium). Normally, this kind of defect would need to be corrected separately, but the surgical team performed both procedures simultaneously during the same operation. They did this by surgically opening the abnormal connection, creating a single unified chamber from the available tissue, and then connecting the donor heart's left atrium to this new chamber, while also tying off an additional abnormal vein (a persistent left superior vena cava) outside the heart.
This research suggests that when a patient undergoing heart transplantation is found to have PAPVR draining into the coronary sinus, the defect can be repaired at the same time as the transplant without the need for a separate operation. The patient was discharged with normal transplanted heart function, indicating the combined procedure was successful. The case highlights the importance of thorough preoperative imaging (CT scan) to identify such anomalies before transplantation so the surgical team can plan appropriately.
The practical implication of this report is that transplant surgeons encountering this anatomical variant need not delay transplantation or subject patients to additional operations — a concomitant repair is technically feasible. Given that PAPVR can be an incidental finding in patients with other heart conditions, transplant teams should be aware of this approach when planning complex cardiac surgeries.
Gabrielle A, Stebbins O, McCullough K, Jaiswal A, Ohira S. (2026). Concomitant orthotopic heart transplantation and repair of left partial anomalous pulmonary venous return.. Multimedia manual of cardiothoracic surgery : MMCTS. https://doi.org/10.1510/mmcts.2026.084