Abstract 15155: Supracardiac Type (1a) Total Anomalous Pulmonary Venous Return with Right to Left Shunt Atrial Septal Defect Diagnosed by 320 Slice CT

Abstract

The first choice of imaging modality to evaluate complex congenital heart disease, especially in infants, is transthoracic echocardiogram (TTE) and magnetic resonance imaging. But to evaluate anatomic details of the heart, including coronary arteries with surrounding structures, CT is most useful. We experienced a patient who was diagnosed as having supracardiac type total anomalous pulmonary venous return (TAPVR) with a right to left shunt atrial septal defect (ASD) by 320 slice CT. A 63-year-old female who had palpitations and dizziness was referred to our hospital because of cardiac enlargement shown on chest X ray in a health examination. On chest X ray, enlargement of protrusion of the right first and left first aortic arches was observed. ECG revealed ectopic low part atrial rhythm, right axis deviation of the QRS wave, and incomplete right bundle branch block. On TTE, ASD with right to left shunt was observed, presence of Eisenmenger syndrome was suspected and there seemed to be no surgical indication. But on TTE, right heart configuration seemed not due to pressure load but volume load, which is not indicative of Eisenmenger syndrome. To evaluate the presence of other complications of anatomical cardiovascular heart disease, ECG-gated 320 slice CT (Aquilion ONE, Toshiba Medical) was performed. On CT, supracardiac type TAPVR with right to left shunt ASD could be accurately diagnosed. She then underwent TAPVR surgical repair from the superior approach in which total PV connected to the LA and ligated innominate vein and ASD pericardial patch closure. By this procedure, there was no blood flow from PV to the right heart, with blood from the PV flowing into the LA directly. Hemodynamics was normalized. In summary, this patient had remarkable cardiac enlargement on chest X-ray, and on TTE ASD with right-to-left shunt was detected. 320 slice CT can evaluate complex congenital heart disease as well as coronary arteries accurately and provide information on blood flow.