Atypical abnormal pulmonary vein drainage with atrial septal defect: surgical treatment.

Sinus venosus atrial septal defect (SV-ASD) usually coexists with partial anomalous pulmonary vein connection (PAPVC). It is a difficult diagnosis in transthoracic echocardiography (TTE) due to eccentric position of defects. We present a rare case of atypical anatomical variation in PAPVC, which was never described before. Two right pulmonary veins drained into superior vena cava, which overrode SV-ASD and interatrial septum, a third pulmonary vein into the right atrium. Complete diagnosis could not be set after TTE, nor transesophageal echocardiography, whereas angio-CT was finally conclusive. This diagnostic approach allowed the surgical planning.