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

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, the authors 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, they 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. They 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.