Case Report: Analysis of the missed diagnosis of atrial septal defect with partial pulmonary vein dual drainage

Objective This study aimed to investigate the reasons for the misdiagnosis of a case of atrial septal defect (ASD) complicated by partial anomalous pulmonary venous connection (PAPVC) to improve clinical diagnosis accuracy in similar cases. Methods The clinical data, imaging findings, and surgical records of a patient with ASD complicated by PAPVC in our department were retrospectively analyzed, and the reasons for the missed diagnosis were comprehensively analyzed in combination with the literature. Results The patient was diagnosed with PAPVC at another hospital; however, neither PAPVC nor ASD was identified on transthoracic echocardiography at our hospital. Cardiac CT and pulmonary angiography showed that the right upper pulmonary vein communicated with both the superior vena cava and the left atrium at the same time; however, the presence of an ASD was still not detected. An upper cavity ASD was found during thoracoscopic orthodontic surgery for downward PAPVC. Conclusion The diagnosis of superior vena cava ASD associated with anomalous pulmonary vein drainage is prone to missed diagnosis, and when the pulmonary vein drains into both the superior vena cava and the left atrium at the same time, it increases the difficulty of detecting PAPAC by echocardiography. During transesophageal echocardiography examination, the integrity of the atrial septum should be repeatedly assessed in multiple sections, and continuous tracking of the pulmonary veins can help reduce the risk of missed diagnoses in similar cases. In addition, surgeons should fully communicate with echocardiographers and imaging specialists before surgery to formulate an individualized surgical plan.