Cross-sectional echocardiographic diagnosis of the sites of total anomalous pulmonary venous drainage.

Abstract

SUMMARY Although there are M-mode echocardiographic criteria for diagnosing total anomalous pulmonary venous drainage (TAPVD), they are not specific and do not provide surgically pertinent information. In this study, we used either a high-frequency mechanical sector scanner or a new electronically focused linear array to examine 125 infants, age 1 day to 3 months, with congenital heart disease and normal pulmonary venous drainage in order to validate and characterize noninvasive imaging of the pulmonary veins draining into the left atrium. Using a combination of apex and subxiphoid four-chamber views, we could image two pulmonary veins in 96 of the 125 and one pulmonary vein in 118 of the 125 patients. Contrast echoes during cardiac catheterization in two patients suggested that the right and left upper pulmonary veins were most commonly imaged. In 10 newborns with persistent fetal circulation, we ruled out obstructive TAPVD and avoided catheterization in each by imaging normally draining pulmonary veins. In seven infants with TAPVD proved by catheterization and surgery, the correct diagnosis was achieved prospectively by cross-sectional echocardiography, even though it was missed by M-mode in four. This study suggests that cross-sectional echocardiography can be used to rule out TAPVD when it is part of a differential diagnosis and that it can accurately diagnose TAPVD noninvasively and suggest the site of drainage.

Pulmonary Venous Flow Index as a Predictor of Pulmonary Vascular Resistance Variability in Congenital Heart Disease with Increased Pulmonary Flow: A Comparative Study before and after Oxygen Inhalation

“…28 Yet, when compared with our data, it remains unclear whether the vein that we studied corresponds to the upper or the lower left pulmonary vein. However, by the location and direction of the vein and in accordance with previous studies, [25][26][27] we believe it was the lower left. In addition, depending on the experience and preference of the echocardiographer, the right superior pulmonary vein can be used for the same purpose.…”

“…The left inferior pulmonary vein can be viewed in children from both the apical and subcostal 4chamber views, opposite to the right superior pulmonary vein and near the left atrial appendage. [25][26][27] However, it is best visualized from the apical four-chamber view with the transducer slightly shifted backwards and with a mild coun- terclockwise rotation in some cases, as a dilated tubular and longitudinal structure in the left lateral wall of the left atrium, extending from the region immediately above the atrioventricular sulcus to the point of drainage inside the atrium near the image of the descending aorta and was previously identified as a new echocardiographic signal of increased pulmonary flow. 11 The pulmonary vein blood flow was identified by color mapping as a blue color, laminar flow and by the pulsed Doppler as a negative deflection moving away from the transducer.…”

Two-Dimensional Echocardiography in Idiopathic Enlargement of the Right Atrium

“…specific echocardiographic features of this entity have not been established as yet. However, two-dimensional echocardiogra phy can exclude some conditions character ized by abnormal right atrium enlargement, such as pulmonary stenosis [18] and pulmo nary hypertension, atrial septal defect [19,20], anomalous pulmonary-venous return [21], etc.…”

Total Anomalous Pulmonary Venous Return and Cor Triatriatum

“…Diagnosis is established by two-dimensional echocardiography and colour Doppler (Sahn et al, 1979;Smallhorn et al, 1981). Squashed left heart secondary to enlarged, hypertensive right ventricle is noted.…”