Total anomalous pulmonary venous connection: impact of prenatal diagnosis

Abstract

Objectives To investigate whether prenatal screening is effective in the detection of total anomalous pulmonary venous connection (TAPVC) and to identify common prenatal features. Methods

Prenatal Findings in Total Anomalous Pulmonary Venous Return

“…More recently, Patel et al 28 reviewed their cohort of 13 patients with a prenatal diagnosis of TAPVR over a 13‐year period. The 2 most recent larger series were published by Seale et al 8 from the United Kingdom in 2012 and Laux et al 14 from France in 2013. The former was a multicenter retrospective study reviewing 8 cases of prenatally diagnosed TAPVR, and the latter had 10 cases.…”

“…However the mid second trimester has only about 15% of the combined ventricular output passing through the lungs, 29 , 30 although this proportion increases to about 25% to 35% of the cardiac output in the third trimester. The small amount of flow return from the lungs early in gestation, with a flow increase only in later gestation, can be a possible reason for inconsistent evidence of a chamber discrepancy before 28 weeks 1 , 8 …”

“…The low incidence of the disease and the difficulties in recognition of abnormalities on obstetric screening sonography that might lead to referral for fetal echocardiography have resulted in a relative paucity of information related to this area in the diagnostic ultrasound literature. The small size of the veins and low flow in the pulmonary venous system make the diagnosis quite difficult 8 , 9 . However, routine antenatal identification of a pulmonary venous connection on the 4‐chamber view within the scope of a screening obstetric examination has been successfully reported, 10 and in recent years, an increasing trend in the number of isolated and series reports describing prenatal diagnosis of anomalous pulmonary venous connections has been noted 1 , 8 , 9 , 11 – 17 .…”

“…The small size of the veins and low flow in the pulmonary venous system make the diagnosis quite difficult 8 , 9 . However, routine antenatal identification of a pulmonary venous connection on the 4‐chamber view within the scope of a screening obstetric examination has been successfully reported, 10 and in recent years, an increasing trend in the number of isolated and series reports describing prenatal diagnosis of anomalous pulmonary venous connections has been noted 1 , 8 , 9 , 11 – 17 . Despite these reports, there is little information in the literature to guide the obstetric ultrasound practitioner in how to systematically assess for TAPVR in a fetus in the setting of second‐ or third‐trimester standard obstetric sonography that includes an anatomic survey.…”

Fetal echocardiography for planning perinatal and delivery room care of neonates with congenital heart disease

“…67 An important risk factor for poor outcome is coexistence of pulmonary vein obstruction, occurring in about 45% of cases and leading to pulmonary venous congestion, pulmonary hypertension, and severe hypoxia soon after birth. 12 68 A more recent study reported that 13% of newborns with obstructed TAPVR were identified prenatally by experienced fetal cardiologists. 12 68 A more recent study reported that 13% of newborns with obstructed TAPVR were identified prenatally by experienced fetal cardiologists.…”