Abstract Body (Do not enter title and authors here):
Introduction:
The use of covered stents in the treatment of sinus venosus defects is an emerging therapy with established efficacy and appears to be a good alternative to surgery in selected cases. Its use in the management for partial anomalous venous return in the absence of a sinus venosus defect is less well-established, and individual cases have been reported though with limited data.

Case description:
A 63-year-old female with hypertension, diabetes mellitus, history of atrial ectopy and supraventricular tachycardia with a previous ablation, presented to the adult congenital heart disease clinic after her recent hospitalization for transient ischemic attack. At baseline, the patient reported reduced activity tolerance, dyspnea, and episodes of palpitations and lightheadedness. Her work-up revealed a positive bubble study with right ventricular dilation prompting coronary CT imaging and cardiac catheterization. She was noted to have anomalous drainage of her right upper pulmonary vein (RUPV) into her superior vena cava (SVC). In addition, she was also noted to have flow from the RUPV into the right middle pulmonary vein (RMPV) draining into the left atrium. Her Qp/Qs ratio was estimated at 2.2 with minimally elevated pulmonary artery pressure. Subsequently, the patient underwent transesophageal echocardiogram-guided stenting of the SVC with a covered stent at the level of the PAPVR and noted resolution of flow from the RUPV to the SVC, and persistent flow from the RUPV into the RMPV, which then drained into the left atrium. Apart from a slight increase in left atrial pressures after stent placement, the patient tolerated the procedure well. On follow-up, the patient demonstrated improvement in her exertional tolerance.

Discussion:
We report a case of isolated PAPVR with favorable anatomy to undergo management with a covered stent. The patient's hospital presentation led to the diagnosis of PAPVR, unmasking a potential reason for her ongoing dyspnea and reduced activity tolerance. The presence of left-to-right shunting, mildly elevated pulmonary pressures, and an additional connection between RUPV and RMPV created favorable hemodynamics for a transcatheter closure of the PAPVR connecting to the SVC. The use of covered stents in the management of PAPVR can prove to be a viable minimally invasive option in patients with favorable hemodynamics and anatomy, and warrants consideration as an initial treatment approach.