Spectrum of M-mode echocardiographic findings in total anomalous pulmonary venous return

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The echocardiographic criteria suggestive of total anomalous pulmonary venous return (TAPVR) have been described as (1) findings of right ventricular volume overload (paradoxic septal motion and a dilated right ventricle) and (2) an echo-free space dorsal to the left atrium.1–5 The classic echocardiographic criteria, however, have been challenged by recent reports as nonspecific and of limited usefulness in the infant group.2, 3, 6 As some infants with TAPVR are minimally cyanotic and have signs of right ventricular volume overload and congestive failure, others are critically ill at birth with pulmonary venous obstruction, severe cyanosis, and pulmonary edema, we believed it was important to describe the spectrum of M-mode echocardiographic findings related to the age and size of the patient, the source of the total anomalous pulmonary venous drainage, the pulmonary artery pressures, and the measurements of right- and left-sided cardiac chamber dimensions. We describe nine pediatric patients with TAPVR: six were beyond the newborn period with anomalous drainage above the diaphragm, and three were critically ill with TAPVR below the diaphragm in the newborn period. These nine cases demonstrate the spectrum of the echocardiographic findings present in this condition.

Patients and methods

The Table describes the various clinical aspects in our patients. There were nine patients, five females and four males in the age range of 20 hours to 12 years (mean, 2.5 years). Five patients were 2 years old or older and three were neonates. The sites of the TAPVR are listed in the Table. The site of the . . .



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