Total anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/coronary sinus instead of the left atrium. We present a case report of fetus with prenatally diagnosed isolated infracardiac type of TAPVC in 38th week of gestation. In fetal echocardiographic examination performed in the Department of Prenatal Cardiology, the fetus presented lack of visible pulmonary veins connection to left atrium, abnormal venous confluence behind left atrium, additional vein leading from abdominal cavity to mediastinum and abnormal smooth Doppler blood flow in pulmonary confluence. The accurate prenatal diagnosis allowed to deliver the neonate at term, in tertiary center one day after diagnosis, and to perform surgical reposition of pulmonary veins the following day. The neonate was referred home in a good condition after 28 days of hospitalization. This case is a good example of the value of the 3rd trimester echocardiography. Key words: total anomalous pulmonary venous return, prenatal diagnosis, fetal echocardiographyCorresponding author: l.sokolowski90@gmail.com Submitted: 2016Submitted: -06-30, accepted: 2016 INTRODUCTIONTotal anomalous pulmonary venous connection (TAPVC) is a congenital heart defect (CHD), in which all pulmonary veins connect to the systemic veins or to the right atrium/ coronary sinus instead of the left atrium. TAPVC is a relatively rare pathology.

Fetal echocardiography, performed on a 22‐year‐old woman at 31 weeks' gestation, revealed a diverticulum of the left atrium. The size of the diverticulum was similar to the size of the fetal heart in a four‐chamber view. No evidence of congestive heart failure or changes in size of the diverticulum were observed on subsequent ultrasound examinations. The echocardiographic image suggested presence of a thrombus within the diverticulum. Echocardiography of the newborn confirmed the diagnosis, and surgical correction followed five days after the birth. Our approach to this problem is discussed here. Copyright © 1999 John Wiley & Sons, Ltd.

Nonatherosclerotic ostial stenosis of left main coronary artery is a rare cause of myocardial ischemia. 1 When ostial coronary stenosis is an isolated lesion, surgical angioplasty may be a valid alternative to standard coronary artery bypass graft operation. 2 We describe a 17-year-old girl with typical angina, hospitalized because of syncope during exercise preceded by chest pain with tight ostial stenosis of short main coronary artery. After a surgical angioplasty with patch of autologous pericardium, a completely noninvasive echocardiographic follow-up was performed, including the assessment of coronary flow reserve, which confirmed good long-term results of operation. Case HistoryA 17-year-old woman with mitral valve prolapse was admitted to the Department of Cardiology because of syncope during exercise preceded by severe chest pain. Detailed history revealed a progressive exercise intolerance with typical anginal chest pain, which had developed over preceding 6 months. The echocardiogram (ECG) performed by medical emergency service showed deep depression of ST segment in the inAddress for correspondence and reprint requests: Karina Wierzbowska-Drabik, M.D., ferior and precordial leads. On admission, resting ECG and biochemistry including cardiac enzymes were normal. No main coronary risk factors such as hypertension, diabetes, dyslipidemia, smoking, or obesity were present. During exercise treadmill test, performed according to Bruce protocol, anginal chest pain was induced and 4 mm ST segment depression in lateral and inferior leads were observed at the level of 4.4 METs. ECG remained abnormal more than 9 minutes of recovery.Resting transthoracic echocardiography showed good left ventricular contractility with ejection fraction 65% and normal wall thickness and cavities dimensions. However, in parasternal short-axis view, a turbulent color flow was recorded in left coronary ostium and proximal part of left anterior descending artery with maximal velocity of 200 cm/sec. These findings were highly suggestive for hemodynamically significant stenosis of left main coronary artery (Fig. 1A). In two-dimensional (2D) imaging (parasternal short-axis view), ostial stenosis of short left main coronary artery was visualized and measurements of diameter of ostium and adjacent segment of the vessel suggested 70% stenosis (Fig. 1B). The patient was referred to coronary angiography, which confirmed 75% ostial stenosis of the left coronary artery (Fig. 1C). No stenotic lesions were observed in distal part of left and in the right coronary artery (which provided collateral flow to peripheral left anterior descending artery through septal branches; Fig. 1D).

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