23 July 2026
: Case report 
A Novel Presentation of Hemodynamic Decompensation With Cardiogenic Shock in a Patient With Partial Anomalous Pulmonary Venous Return
Congenital defects / diseases
Wafaa Mansour AEF 1*, Jamil Qiqieh
EF 1, Johnathan Stephan E 2, Sara Gezahegn EF 3, Fadi Ayoub E 1, Dawit K. Worku E 3, Alehegn Gelaye EF 3
DOI: 10.12659/AJCR.953243
Am J Case Rep 2026; 27:e953243
Table 3 Clinical timeline of presentation, hospital course, management, and outcomes of the case.
| Timepoint | Clinical events |
|---|---|
| 2 years prior | Diagnosed with PAPVR involving right lower lobe pulmonary vein draining into azygos vein; Qp: Qs ~2: 1; RVSP 101 mmHg; PBF 8.79 L/min; PVR 5.2 Wood units |
| Prior 2 years | Multiple admissions for heart failure exacerbations; no prior intubation or ICU admission |
| 1 week prior to admission | Progressive dyspnea |
| Day 0 (presentation) | Volume overload on exam; CXR: cardiomegaly and pulmonary congestion; admitted for acute decompensated heart failure; initiated on diuresis |
| Hospital Day 1 | Respiratory deterioration → rapid response; ABG: severe hypercapnia (PaCO 116 mmHg, pH 7.13); BiPAP initiated but failed; required intubation and ICU transfer |
| ICU course (Days 1–3) | Ventilated (PEEP 5 cmHO, FiO 40%, RR 12); improvement in ABG by day 2; tidal volumes reduced from 450 mL to 400 mL |
| Cardiac evaluation | TTE: LVEF 72%, severe RV dilation, reduced RV function, septal flattening; CVP 20 mmHg; severe RA enlargement |
| Shock management | Cardiogenic shock treated with cautious diuresis and norepinephrine; milrinone added for inotropic support and pulmonary vasodilation |
| Hospital Days 2–5 | Gradual improvement in respiratory and hemodynamic status |
| Post-ICU course | Successfully extubated; continued diuresis (bumetanide) and sildenafil |
| Within 1 week after extubation | Weaned off supplemental oxygen; discharged in stable condition |
| Post-discharge plan | Follow-up arranged with pulmonology, cardiology, and cardiothoracic surgery for surgical evaluation |
| 1 month after discharge | Fatal intracranial hemorrhage |