CASE REPORT Rheumatic mitral stenosis associated with sinus venosus atrial septal defect and partial anomalous pulmonary venous return Vithalkumar Malleshi Betigeri • Anupama Vithalkumar Betigeri • Balkrishnan Karthikeyan • Kasturi Satya Venkata Kumar SubbaRao Received: 11 May 2013 / Accepted: 13 July 2013 Ó The Japanese Association for Thoracic Surgery 2013 Abstract In medical literature, the association of acquired and congenital heart disease is interestingly well known, but uncommon. We report a case of young male adult whose therapeutic management for rheumatic mitral stenosis is changed as sinus venosus atrial septal defect was detected by transesophageal echocardiography. Presence of partial anomalous pulmonary venous return of right supe- rior pulmonary vein into the superior vena cava detected in transesophageal echocardiography was confirmed at the operation which was successfully carried out to correct all three abnormalities through the right atrial approach. Keywords Sinus venosus defect Á Partial anomalous pulmonary venous return Á Mitral stenosis Á Transesophageal echocardiography Introduction Since the description by Lutembacher, the association of acquired valvular lesion with congenital lesion is increasingly reported. We report the rare occurence of concomitant congenital and acquired heart disease in form of sinus venosus atrial septal defect (SVD), partial anom- alous pulmonary venous return (PAPVR) into the superior vena cava (SVC) associated with an acquired mitral valve stenosis in young adult male patient. Case A 33-year-old male of known rheumatic mitral stenosis referred to our institute with transthoracic echocardio- graphic (TTE) diagnosis of severe mitral stenosis, mild tricuspid regurgitation, severe pulmonary artery hyperten- sion and good left ventricular contractility for therapeutic percutaneous intervention. Acyanotic patient without clubbing, with peripheral oxygen saturation of 98 % at rest on room air, 96 % on exertion, had raised jugular venous pressure, regular pulse at 86 beats/min, and the blood pressure of 101/68 mmHg. Precordium had right ventric- ular heave grade III and laterally displaced apical impulse in anterior axillary line, 5th intercostal space. The first heart sound and the pulmonic component of the second heart sound were accentuated. The splitting and movement of the components of the second sound with respiration were not clear. Mid-diastolic murmur could be heard in the vicinity of the left ventricular apex along with opening snap. Electrocardiogram showed normal sinus rhythm, right-axis deviation, incomplete right bundle branch and right ventricular hypertrophy. Cardiomegaly, dilated pul- monary arteries, and pulmonary plethora were noted in the chest X-ray. The plan of percutaneous transvenous mitral commissurotomy was postponed as repeat TTE done in view of marked enlarged right atrium (RA), right ventricle and main pulmonary artery, suspected shunt across the V. M. Betigeri Á K. S. V. K. SubbaRao Department of Cardiovascular and Thoracic Surgery, JIPMER, Puducherry, India V. M. Betigeri (&) Department of CTVS, MAMC and GB Pant Hospital, New Delhi 110002, India e-mail: vithalkumarmb@gmail.com A. V. Betigeri Department of Physiology, JIPMER, Puducherry, India B. Karthikeyan Department of Cardiology, JIPMER, Puducherry, India 123 Gen Thorac Cardiovasc Surg DOI 10.1007/s11748-013-0293-6