125 DIACNOSIS OF TOTAL ANOMALOUS PULMONARY VENOUS RETURN COMBINED WITH PULSED DOPPLER, M-MODE AND TWO-DIMENSIONAL ECHOCARDIOGRAPHY

Abstract

Depiction of an echo-free space (EPS) behind the LA by M-mode and 2D echo is suggestive of total anomalous pulmonary venous return (TAPVR). 2D often shows that pulmonary veins do not drain into the LA but the pulmonary venous connections are difficult to image in respiratory distress. 2D may identify the drainage site of the common venous channel (CV). However, in TAPVR into coronary sinus (CS), dilated CS may be confused with LA. Pulsed Doppler (PD) improves the accuracy of the echo evaluation. We studied 10 patients with TAPVR with M-mode, 2D, and PD echo, before angiography. Ages ranged 1-135 days (median 19.2); 8/10 less than 7 days old. M-mode demonstrated an EPS behind LA in 6/10; LA size was small in 7/10; LV size was small in 10/10 and RV size was enlarged in 7/10; 4 had paradoxical septal motion. 2D showed EPS behind LA in 7/10 and the drainage site of the CV was identified in 7/10. PD detected continuous turbulent flow in the CV and/or at its entry site in 9/10. All were confirmed at surgery or autopsy. In one pt with TAPVR to the CS, 2D showed large RV, a small LA and LV but not EPS; PD didn't demonstrate unusual or continuous flow disturbance. Conclusion: M-mode and 2D identify the EPS representing the CV in a majority of pts with TAPVR and 2D may demonstrate drainage site of the CV. M-mode reveals a small LV in all and a small LA and large RV in a majority. Addition of PD to M-mode and 2D enhanced accuracy of detection of TAPVR and the site of drainage.