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

Abstract

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. Either a high-frequency mechanical sector scanner or a new electronically focused linear array was used to examine 125 infants, age 1 day to 3 mo., with congenital heart disease and normal pulmonary venous drainage to validate and characterize noninvasive imaging of the pulmonary veins draining into the left atrium. Using a combination of apex and subxiphoid 4-chamber views, 2 pulmonary veins were imaged in 96 of the 125 and 1 pulmonary vein in 118 of the 125 patients. Contrast echoes during cardiac catheterization in 2 patients suggested that the right and left upper pulmonary veins were most commonly imaged. In 10 newborns with persistent fetal circulation, obstructive TAPVD were ruled out and catheterization was avoided in each by imaging normally draining pulmonary veins. In 7 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 4. Cross-sectional echocardiography probably can be used to rule out TAPVD when it is part of a differential diagnosis and it apparently can accurately diagnose TAPVD noninvasively and suggest the site of drainage.