PMC9280092_01
CT scan at the time of diagnosis showing the anomalous drainage of the right lower pulmonary vein into the IVC (arrows). IVC: Inferior vena cava, RLPV: Right lower pulmonary vein, CT: Computed tomography
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F1
A computed tomography (CT) scan revealed an anomalous drainage of the right lower pulmonary vein into the suprahepatic segment of the IVC, which was missed on the echocardiogram [Figure 1].
(a) Angiography in the right lower pulmonary vein showing its drainage to the IVC and a filiform stenosis (arrow) at the junction between the IVC-right atrium junctions, (b) angiography in the left lower pulmonary vein showing a stenosis (arrow) at its connection to the left atrium. IVC: Inferior vena cava
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F2
Further, cardiac catheterization showed a filiform stenosis at the IVC to right atrium junction, above the drainage of the lower right pulmonary vein [Figure 2a], and a stenosis of 2.1 mm in the left pulmonary venous confluence [Figure 2b], which was treated with a Maverick XL  6 mm x 20 mm balloon dilation with initial satisfactory result.
(a) Hybrid "stop-flow" angiography showing a stenosis at the distal end (black arrow) of the stent previously implanted at the collector of the left pulmonary veins (white arrow), (b) resolution of the stenosis after new stent implantation. The previously implanted stents in the right superior pulmonary vein (white arrow) and in the IVC (black arrow) are also shown. IVC: Inferior vena cava
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F3
At this time, another hybrid procedure was performed, showing a stenosis of the collector distal to the previously placed stent [Figure 3a], which resolved with the placement of a new stent [Figure 3b].
CT scan at the age of 7 showing patency of the stents implanted in the left pulmonary veins. CT: Computed tomography
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F4
At his last clinical assessment at the age of 7 years, the patient had a good functional class and noninvasive imaging (echocardiogram and CT scan) revealed obliteration of the lower right pulmonary vein into the IVC connection with collateral circulation into the vascular territory of the right upper pulmonary vein and mild stenosis of the stents placed in the left pulmonary veins [Figure 4].
CT scan at diagnosis showing the presence of a horseshoe lung (black arrow) in addition to a stenosis of the main right pulmonary bronchus (white arrow). CT: Computed tomography
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F5
A CT scan revealed a horseshoe lung [Figure 5] and two aortopulmonary collateral arteries arising from the descending abdominal aorta to the base of the right lung.
(a) Angiography in the thoracic descending aorta (white arrow) showing two large collateral arteries (black arrows) to the right lung, (b) both collateral arteries were embolized with multiple coils (black arrows) and two Amplatzer Vascular Plug 4  (white arrows)
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F6
The two aortopulmonary collaterals were embolized during the procedure with a decrease in the pulmonary to systemic pressure down to 46% [Figure 6].