Bhingardeo A V^1*, Bhoir M², Mundada K V³

¹Registrar, ²Professor, ³Second MBBS student, Department of Anatomy, HBTMCand Dr. R. N.  Cooper Municipal General Hospital Mumbai, Maharashtra, INDIA.

Email: dr.alkabhingardeo@gmail.com

Table 2: Variations in Right pulmonary veins

Table 3: Variations in Left pulmonary veins

                                               Figure 1                                           Figure 2                                                 Figure 3

Figure 1: Three superiorright pulmonary veins; Figure 2: Four inferior right pulmonary veins; Figure 3: Two right superior and two right inferior pulmonary veins.

DISCUSSION

Accessory pulmonary veins occur by over incorporation of the pulmonary veins beyond their first division. Such variations in draining pattern of pulmonary veins act as ectopic focus causing cardiac arrhythmia¹² We found variations in 13 hearts out of 33.Variations were more common on right side (39.39%) than on left side (9.09%). This is in agreement with studies by other authors.^{2, 3} Prasanna et al¹³ found variations in right pulmonary veins in 28% of cases while in left pulmonary veins in only 6% of cases while Kaur et al⁸ found 26% of cases who showed variations on right side while 23% of cases showing variations on left side. Most common variation in right pulmonary vein was the presence of 3 veins with 3 ostia. It was found in 18.2% of cases. Marom et al¹⁰ found the same variation in 24% of cases while Lovesh shukla¹¹ et al found it in 6.9% of cases. Maximum number of veins on right side was 4 which is found in four cases in the present study. Prasanna et al¹³ and other authors reported the maximum number of veins up to five. The draining pattern of left pulmonary veins in maximum cases (96.96%) were normal with 2 pulmonary veins with 2 ostia. This result matches with findings of Marom et al¹⁰ (86%) and Prasanna et al¹³ (79.3%). The most common variation found on left side was the presence of 3 pulmonary veins with 2 ostia which is found in 3% of cases. Lovesh shukla¹¹ found the same variation in 3.4% of cases. Out of total 13 variations, three hearts showed drainage of accessory veins by forming common stem while in remaining ten cases, accessory veins were found to have independent ostia. Variation in number of pulmonary veins leads to Cardiac arrhythmia which is the most common cause of cardiac morbidity and mortality⁸ Therefore knowledge of pulmonary venous drainage pattern is necessary. Radiofrequency ablation procedure is carried out for such ectopic foci resulting from variant pulmonary veins.⁹ The information regarding pulmonary venous drainage guides interventionist to reach the specific location of ectopic tissue of atrial activity and reduce the complications of missing ectopic foci in radiofrequency ablation procedures.⁸

CONCLUSION

The findings of present study confirmed that there are variations in the number and draining pattern of pulmonary veins. Knowledge of such variations is necessary for radiologist and thoracic surgeons before doing any procedure involving pulmonary veins like radiofrequency ablation procedure for cardiac arrhythmia, pulmonary lobectomy, cardiac valve replacements to avoid post post procedural complications.^11,14

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