BACKGROUND
Partial anomalous pulmonary venous return (PAPVR) is a rare congenital cardiovascular anomaly that can remain clinically silent until significant shunting results in pulmonary hypertension and right ventricular dysfunction. We report a rare presentation of PAPVR complicated by acute right-sided cardiogenic shock in a previously stable adult, highlighting the potential for abrupt decompensation in advanced disease.
CASE REPORT
A 51-year-old African American man with known PAPVR and pulmonary hypertension presented with 1 week of progressive dyspnea, rapidly developing acute respiratory failure requiring BiPAP. His condition deteriorated within 24 hours, requiring intubation and intensive care unit (ICU) admission. Transthoracic echocardiography demonstrated severe right ventricular dilation, reduced systolic function, and septal flattening consistent with pressure overload. He developed right-sided cardiogenic shock requiring inotropes, vasopressors, and aggressive diuresis. After stabilization, he was extubated and discharged with plans for surgical evaluation. This case report highlights a rare presentation of PAPVR in which cardiogenic shock was caused by initial critical decompensation. Despite initial recovery, he did not undergo corrective intervention, as he later fell at home and had a fatal intracranial hemorrhage, illustrating the importance of early recognition, close follow-up, and timely surgical consideration.
CONCLUSIONS
Because PAPVR is often asymptomatic and considered benign, it is frequently managed conservatively; however, risk stratification based on shunt magnitude, right ventricular remodeling, and pulmonary pressures is essential. Patients with large shunts and pulmonary hypertension, as in our case, may be at risk of rapid decompensation, requiring prompt diagnosis, close monitoring, and early surgical evaluation.

Keywords: Cardiology; Cardiomyopathies; Critical Care; Pulmonary Adenomatosis, Ovine; Pulmonary Circulation; Ventricular Dysfunction, Right