Total anomalous pulmonary venous return involving drainage above, below, and to the heart: A mixed bag

Abstract

Total anomalous pulmonary venous return (TAPVR) is defined as abnormal drainage of the pulmonary venous blood to the systemic venous system. TAPVR can be classified by the location of the abnormal drainage as being supracardiac (type I), cardiac (type II), infracardiac (type III), or mixed (type IV).1 Most of these connections involve a common pulmonary venous confluence that then drains to the specified site. Accurate definition of the sites of drainage is important in determining the appropriate surgical approach. Two-dimensional echocardiography with color flow Doppler has been shown to accurately establish the diagnosis.2 We present an interesting case of type IV mixed TAPVR diagnosed by echocardiography that involves all 3 locations (types I-III) with no common pulmonary venous confluence and no other major associated cardiac abnormalities. To our knowledge, this has not been previously described.