Letter to the Editor
Partial Anomalous Pulmonary Venous Connection With Pulmonary Hypertension
Conexión venosa pulmonar anómala parcial con hipertensión pulmonar
Julio Hernández Vázqueza,
, Javier de Miguel Díezb, Cristina de Cortina Camareroc
Corresponding author
a Servicio de Neumología, Hospital Infanta Leonor, Madrid, Spain
b Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
c Servicio de Cardiología, Hospital Infanta Leonor, Madrid, Spain
Read
5856
Timeswas read the article
1884
Total PDF
3972
Total HTML
Share statistics
array:23 [ "pii" => "S1579212914004066" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.12.013" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "952" "copyright" => "SEPAR" "copyrightAnyo" => "2013" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:153-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2607 "formatos" => array:3 [ "EPUB" => 144 "HTML" => 1885 "PDF" => 578 ] ] "Traduccion" => array:1 [ "es" => array:18 [ "pii" => "S0300289614001215" "issn" => "03002896" "doi" => "10.1016/j.arbres.2014.03.009" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "952" "copyright" => "SEPAR" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:153-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 4295 "formatos" => array:3 [ "EPUB" => 123 "HTML" => 3590 "PDF" => 582 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta al Director</span>" "titulo" => "Conexión venosa pulmonar anómala parcial con hipertensión pulmonar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "153" "paginaFinal" => "154" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Partial Anomalous Pulmonary Venous Connection With Pulmonary Hypertension" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1320 "Ancho" => 2333 "Tamanyo" => 195681 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Radiografía de tórax, proyección posteroanterior: doble contorno en la línea mediastínica izquierda (flechas), debido al trayecto ascendente del vaso venoso anómalo. B) Tomografía computarizada con contraste, plano axial: vaso venoso anómalo paraaórtico izquierdo (cabeza de flecha), responsable del doble contorno.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Julio Hernández Vázquez, Javier de Miguel Díez, Cristina de Cortina Camarero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Julio" "apellidos" => "Hernández Vázquez" ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "de Miguel Díez" ] 2 => array:2 [ "nombre" => "Cristina" "apellidos" => "de Cortina Camarero" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212914004066" "doi" => "10.1016/j.arbr.2014.12.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914004066?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001215?idApp=UINPBA00003Z" "url" => "/03002896/0000005100000003/v2_201502240247/S0300289614001215/v2_201502240247/es/main.assets" ] ] "itemSiguiente" => array:18 [ "pii" => "S157921291400408X" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.12.015" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "954" "copyright" => "SEPAR" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:154-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 7413 "formatos" => array:3 [ "EPUB" => 157 "HTML" => 6560 "PDF" => 696 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Chronic Obstructive Pulmonary Disease Exacerbation by <span class="elsevierStyleItalic">Corynebacterium propinquum</span>" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "154" "paginaFinal" => "155" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Exacerbación de la enfermedad pulmonar obstructiva crónica por <span class="elsevierStyleItalic">Corynebacterium propinquum</span>" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Iván Prats-Sánchez, María José Soler-Sempere, Victoria Sánchez-Hellín" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Iván" "apellidos" => "Prats-Sánchez" ] 1 => array:2 [ "nombre" => "María José" "apellidos" => "Soler-Sempere" ] 2 => array:2 [ "nombre" => "Victoria" "apellidos" => "Sánchez-Hellín" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289614001239" "doi" => "10.1016/j.arbres.2014.03.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289614001239?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S157921291400408X?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000003/v2_201502230226/S157921291400408X/v2_201502230226/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1579212914004042" "issn" => "15792129" "doi" => "10.1016/j.arbr.2014.12.011" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "857" "copyright" => "SEPAR" "documento" => "simple-article" "subdocumento" => "cor" "cita" => "Arch Bronconeumol. 2015;51:152" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2764 "formatos" => array:3 [ "EPUB" => 140 "HTML" => 2160 "PDF" => 464 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Status of the Ban on Asbestos Use in Spain and Latin America" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "152" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Situación de la prohibición del uso de asbesto en España y Latinoamérica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Roberto Alfonso Accinelli Tanaka, Lidia Marianella López Oropeza" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Roberto Alfonso" "apellidos" => "Accinelli Tanaka" ] 1 => array:2 [ "nombre" => "Lidia Marianella" "apellidos" => "López Oropeza" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613003372" "doi" => "10.1016/j.arbres.2013.11.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613003372?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914004042?idApp=UINPBA00003Z" "url" => "/15792129/0000005100000003/v2_201502230226/S1579212914004042/v2_201502230226/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Partial Anomalous Pulmonary Venous Connection With Pulmonary Hypertension" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "153" "paginaFinal" => "154" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Julio Hernández Vázquez, Javier de Miguel Díez, Cristina de Cortina Camarero" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Julio" "apellidos" => "Hernández Vázquez" "email" => array:1 [ 0 => "julio.hernandez@salud.madrid.org" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Javier" "apellidos" => "de Miguel Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Cristina" "apellidos" => "de Cortina Camarero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología, Hospital Infanta Leonor, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Neumología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Cardiología, Hospital Infanta Leonor, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Conexión venosa pulmonar anómala parcial con hipertensión pulmonar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 792 "Ancho" => 1400 "Tamanyo" => 125590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest radiograph, posteroanterior view: double density sign on the left mediastinal border (arrows) caused by the ascending path of the defective venous vessel. (B) Contrast-enhanced computed tomography, axial plane: anomalous venous vessel (arrowhead) causing the double density.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Partial anomalous pulmonary venous connection (PAPVC) encompasses a group of cardiovascular anomalies that are caused by the abnormal return of one or more of the pulmonary veins directly to the right atrium or indirectly through a variety of venous connections from the anomalous pulmonary veins.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 51-year-old man, a former smoker, with a history of hypertension, diabetes, dyslipidemia and peripheral artery disease, who reported dyspnea on moderate exertion lasting several months. Laboratory test results (including serologic studies for hepatotropic viruses) were normal. Spirometry tests showed mild obstruction, and plethysmography and diffusing capacity measurements were normal. Chest radiography revealed enlargement of both hila and their vascular markings, with a double density sign on the left paratracheal area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). The echocardiogram showed: normal left ventricle, right ventricle severely dilated, and indirect signs of pulmonary hypertension (PH). Right heart catheterization showed slight PH (mean PAP 29<span class="elsevierStyleHsp" style=""></span>mmHg, total PVR 254.84<span class="elsevierStyleHsp" style=""></span>dyn.s.cm<span class="elsevierStyleSup">−5</span>). On computed tomography (CT) scan, an anomalous venous structure was seen in which the left pulmonary veins converged, draining into the brachiocephalic vein (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). Based on these findings, the patient underwent surgery (anastomosis of the defective left vein to the left atrium) and was discharged with antiplatelet therapy in addition to his usual medication. This improved his dyspnea. The follow-up echocardiogram at 3 years showed: normal left and right ventricle, no PH.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">There are 2 types of PAPVC: partial anomalous pulmonary venous connections and partial anomalous pulmonary venous drainage.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> In the first, an anomalous vein connects with a systemic vein, so that oxygenated blood from the pulmonary circulation mixes with the systemic venous blood, before draining into the right atrium; the most common form is drainage of the left upper pulmonary vein into the brachiocephalic vein. In the second, the pulmonary veins are correctly connected to the left atrium, but venous pulmonary blood flows into the right atrium or into both atria through a cardiac defect.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Although PAPVC can present as an isolated structural abnormality, it is often associated with other heart defects.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The severity of symptoms depends on the extent of the left-right short circuit<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> and the presence of other cardiac or pulmonary abnormalities. A preliminary diagnosis can be made with echocardiography and then confirmed with CT, magnetic resonance imaging or heart catheterization. Pulmonary angiography gives a more detailed anatomical image.</p><p id="par0025" class="elsevierStylePara elsevierViewall">PAPVC must be treated surgically, although this can be avoided in asymptomatic patients with a minor short circuit.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> In some cases, even occlusion by catheterization can be considered.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> Prognosis for PAPVC patients is generally good.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although these are congenital malformations, they can go unnoticed until adulthood. Given that up to 42.8% of PAPVC patients can present PH,<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> clinicians should aware of the danger of diagnosing PAPVC patients with primary PH, since the therapeutic approach is very different in both cases.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Hernández Vázquez J, de Miguel Díez J, de Cortina Camarero C. Conexión venosa pulmonar anómala parcial con hipertensión pulmonar. Arch Bronconeumol. 2015;51:153–154.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 792 "Ancho" => 1400 "Tamanyo" => 125590 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Chest radiograph, posteroanterior view: double density sign on the left mediastinal border (arrows) caused by the ascending path of the defective venous vessel. (B) Contrast-enhanced computed tomography, axial plane: anomalous venous vessel (arrowhead) causing the double density.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Partial anomalous pulmonary venous connection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D.R. Fulton" 1 => "B. Soriano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "UpToDate" "serieFecha" => "2013" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Partial anomalous pulmonary venous connection and pulmonary arterial hypertension" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Sahay" 1 => "R.A. Krasuski" 2 => "A.R. Tonelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1843.2012.02180.x" "Revista" => array:6 [ "tituloSerie" => "Respirology" "fecha" => "2012" "volumen" => "17" "paginaInicial" => "957" "paginaFinal" => "963" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22509787" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Drainage of the pulmonary veins into the right side of the heart" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Brody" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Pathol" "fecha" => "1942" "volumen" => "33" "paginaInicial" => "221" "paginaFinal" => "240" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Major vascular anomalies in Turner syndrome: prevalence and magnetic resonance angiographic features" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V.B. Ho" 1 => "V.K. Bakalov" 2 => "M. Cooley" 3 => "P.L. Van" 4 => "M.N. Hood" 5 => "T.R. Burklow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/01.CIR.0000142290.35842.B0" "Revista" => array:6 [ "tituloSerie" => "Circulation" "fecha" => "2004" "volumen" => "110" "paginaInicial" => "1694" "paginaFinal" => "1700" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15353492" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An unusual cause of dyspnea diagnosed late in life: severe pulmonary hypertension resulting from isolated anomalous pulmonary venous connection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.C. Clarke" 1 => "J.R. Aragam" 2 => "D.L. Bhatt" 3 => "J.D. Brown" 4 => "S. Ferrazzani" 5 => "D.A. Pietro" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1161/CIRCIMAGING.112.000145" "Revista" => array:6 [ "tituloSerie" => "Circ Cardiovasc Imaging" "fecha" => "2013" "volumen" => "6" "paginaInicial" => "349" "paginaFinal" => "351" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23512781" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005100000003/v2_201502230226/S1579212914004066/v2_201502230226/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005100000003/v2_201502230226/S1579212914004066/v2_201502230226/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914004066?idApp=UINPBA00003Z" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 8 | 1 | 9 |
| 2024 October | 42 | 20 | 62 |
| 2024 September | 34 | 15 | 49 |
| 2024 August | 49 | 44 | 93 |
| 2024 July | 51 | 17 | 68 |
| 2024 June | 66 | 33 | 99 |
| 2024 May | 91 | 26 | 117 |
| 2024 April | 38 | 25 | 63 |
| 2024 March | 35 | 18 | 53 |
| 2024 February | 30 | 20 | 50 |
| 2023 March | 12 | 6 | 18 |
| 2023 February | 52 | 20 | 72 |
| 2023 January | 46 | 27 | 73 |
| 2022 December | 65 | 29 | 94 |
| 2022 November | 58 | 33 | 91 |
| 2022 October | 67 | 35 | 102 |
| 2022 September | 55 | 38 | 93 |
| 2022 August | 48 | 37 | 85 |
| 2022 July | 33 | 35 | 68 |
| 2022 June | 47 | 38 | 85 |
| 2022 May | 50 | 35 | 85 |
| 2022 April | 55 | 35 | 90 |
| 2022 March | 46 | 42 | 88 |
| 2022 February | 57 | 31 | 88 |
| 2022 January | 42 | 38 | 80 |
| 2021 December | 32 | 34 | 66 |
| 2021 November | 43 | 39 | 82 |
| 2021 October | 39 | 36 | 75 |
| 2021 September | 36 | 40 | 76 |
| 2021 August | 22 | 42 | 64 |
| 2021 July | 29 | 30 | 59 |
| 2021 June | 33 | 32 | 65 |
| 2021 May | 37 | 30 | 67 |
| 2021 April | 122 | 69 | 191 |
| 2021 March | 63 | 25 | 88 |
| 2021 February | 31 | 30 | 61 |
| 2021 January | 32 | 27 | 59 |
| 2020 December | 44 | 30 | 74 |
| 2020 November | 29 | 18 | 47 |
| 2020 October | 36 | 14 | 50 |
| 2020 September | 22 | 11 | 33 |
| 2020 August | 36 | 10 | 46 |
| 2020 July | 48 | 23 | 71 |
| 2020 June | 26 | 10 | 36 |
| 2020 May | 40 | 18 | 58 |
| 2020 April | 35 | 16 | 51 |
| 2020 March | 50 | 20 | 70 |
| 2020 February | 47 | 15 | 62 |
| 2020 January | 34 | 17 | 51 |
| 2019 December | 47 | 16 | 63 |
| 2019 November | 46 | 21 | 67 |
| 2019 October | 36 | 12 | 48 |
| 2019 September | 44 | 9 | 53 |
| 2019 August | 47 | 13 | 60 |
| 2019 July | 44 | 16 | 60 |
| 2019 June | 55 | 12 | 67 |
| 2019 May | 62 | 31 | 93 |
| 2019 April | 61 | 43 | 104 |
| 2019 March | 51 | 22 | 73 |
| 2019 February | 36 | 21 | 57 |
| 2019 January | 34 | 16 | 50 |
| 2018 December | 36 | 18 | 54 |
| 2018 November | 54 | 27 | 81 |
| 2018 October | 92 | 22 | 114 |
| 2018 September | 33 | 11 | 44 |
| 2018 May | 12 | 0 | 12 |
| 2018 April | 25 | 4 | 29 |
| 2018 March | 30 | 4 | 34 |
| 2018 February | 40 | 4 | 44 |
| 2018 January | 94 | 5 | 99 |
| 2017 December | 93 | 3 | 96 |
| 2017 November | 28 | 4 | 32 |
| 2017 October | 29 | 7 | 36 |
| 2017 September | 26 | 10 | 36 |
| 2017 August | 55 | 10 | 65 |
| 2017 July | 29 | 9 | 38 |
| 2017 June | 58 | 14 | 72 |
| 2017 May | 43 | 3 | 46 |
| 2017 April | 32 | 7 | 39 |
| 2017 March | 31 | 39 | 70 |
| 2017 February | 18 | 4 | 22 |
| 2017 January | 16 | 4 | 20 |
| 2016 December | 26 | 3 | 29 |
| 2016 November | 32 | 9 | 41 |
| 2016 October | 30 | 8 | 38 |
| 2016 September | 37 | 11 | 48 |
| 2016 August | 35 | 9 | 44 |
| 2016 July | 34 | 14 | 48 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 41 | 4 | 45 |
| 2015 September | 42 | 11 | 53 |
| 2015 August | 34 | 15 | 49 |
| 2015 July | 37 | 11 | 48 |
| 2015 June | 37 | 11 | 48 |
| 2015 April | 0 | 2 | 2 |
| 2015 March | 0 | 1 | 1 |
Show all
