4D flow MRI as a preoperative assessment tool for patients undergoing lobectomy for partial anomalous pulmonary venous return

Introduction: Partial anomalous pulmonary venous return is a congenital malformation. The abnormal pulmonary to systemic blood flow ratio may affect general anesthesia. Therefore, it is important to figure out pulmonary to systemic blood flow ratio before surgery. Case Report: A 62-year-old man was referred to our hospital. Close examination of a patient suspected with right upper lobe lung cancer revealed partial anomalous pulmonary venous return in the same lobe. Generally, if partial anomalous pulmonary venous return is present in the lung lobe to be resected, surgery can be performed as planned. However, we performed 4D flow magnetic resonance imaging (MRI) to evaluate pulmonary to systemic blood flow ratio for safer anesthesia and surgery. His pulmonary to systemic blood flow ratio was 1.04, which seemed safe for general anesthesia and surgery. Right upper lobectomy was performed, and the patient was discharged on postoperative day 7 without any circulatory complications. Conclusion: We found that 4D flow MRI contributed to a safe perioperative management and it must be meaningful for partial anomalous pulmonary venous return in the other lobe.