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December 1972

Safety Valve Function in Partial Anomalous Pulmonary Venous Drainage With Mitral Stenosis

Author Affiliations

New Orleans

From the departments of surgery (Drs. Hyman and Woolverton) and pathology (Dr. Ichinose), Tulane University School of Medicine, New Orleans.

Arch Intern Med. 1972;130(6):931-934. doi:10.1001/archinte.1972.03650060119022

Early speculations suggested that, should mitral stenosis develop in a patient with partial anomalous pulmonary venous connection, the latter lesions would act as a sort of safety valve; pulmonary congestion following left atrial hypertension could be modulated by shunting blood into the normotensive systemic veins.1 Hemodynamic studies in only one reported patient support this suggestion2; the others have failed to substantiate this prediction.3-7 On the contrary, a higher pulmonary vascular resistance has always been found in the anomalously draining region than in the normally draining region; it has been suggested that this increased resistance to flow serves as a compensatory mechanism, limiting flow through the anomalously draining lung.2-5 This report describes the hemodynamic findings in a patient with severe pulmonary hypertension and mitral stenosis with increased blood flow per unit area through an anomalously draining left upper lobe. Amelioration was produced by mitral valve prosthesis without