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In infancy, total anomalous pulmonary venous return above the diaphragm and congenital cerebral arteriovenous malformations are difficult to diagnose. To assist in diagnosing these lesions, the brachiocephalic vein (BCV) and transverse arch diameters were obtained and compared, to provide a BCV index, the ratio of the BCV diameter to the transverse arch diameter. Fifty-six infants were studied. Six infants had arteriovenous malformations (mean age, 46 ± 76 days; mean weight, 3.8 ± 1.2 kg). Eight infants had total anomalous pulmonary venous return draining above the diaphragm (mean age, 22 ± 30 days; mean weight, 3.2 ± 0.5 kg). A healthy control group (those without heart disease) consisted of 42 infants (mean age, 23 ± 47 days, mean weight 3.0 ± 1.4kg). There were no significant differences in the age, gender, and weight of these patients versus the controls. An absolute BCV diameter of 0.52 cm and a brachiocephalic vein (BCV/transverse arch) index greater than 1.06 should alert the sonographer to the presence of an arteriovenous malformation or total anomalous pulmonary venous return above the diaphragm. This finding will then permit a greater focus on identifying the course of the anomalous venous channels.

Accessory mitral valve tissue is a rare cause of intracardiac mass and subvalvular left ventricular outflow tract obstruction. The preoperative diagnosis of this congenital anomaly has been facilitated by transthoracic two-dimensional and Doppler echocardiography. However, transthoracic two-dimensional echocardiography cannot identify or correctly diagnose all cases of accessory mitral valve tissue. We report a patient in whom an intracardiac mass detected by transthoracic echocardiography was definitively diagnosed as accessory mitral valve tissue by transesophageal echocardiography.

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