Vise Location of the Vertical Vein in a Neonate With a Supracardiac Total Anomalous Pulmonary Venous Connection

Abstract

A newborn delivered at 37 weeks of gestation with a birth weight of 2,526 g was transferred to our hospital because of respiratory distress and cyanosis. The neonate had a heart rate of 140 beats/min and a respiratory rate of 50 breaths/min. The oxygen saturation was 75%. At auscultation, the pulmonary second heart sound was accentuated, and venous hum was noted in the second intercostal space of the left sternal border. Hepatomegaly also was noted. A chest X-ray showed a cardiothoracic ratio of 58%, with increased pulmonary congestion (Fig. 1). Echocardiography showed that the right heart was markedly enlarged and that all the pulmonary veins joined behind the left atrium connected to the innominate vein via the vertical vein, consistent with a supracardiac total anomalous pulmonary venous connection (TAPVC). Doppler imaging showed that the flow velocity was increased at the vertical vein. An atrial septal defect with right-to-left shunting and a large patent ductus arteriosus with a bidirectional shunt also were shown. Multidetector computed tomography (MDCT) (64 detectors) performed on the second day of age showed the horizontal common pulmonary vein draining to the left innominate vein via the vertical vein. The vertical vein ascended anteriorly to the left pulmonary artery and posteriorly to the ductus arteriosus and left bronchus, which was externally compressed by the ductus rather than the left bronchus (Figs. 2, 3). On the third day of age, we performed surgical correction using a cardiopulmonary bypass. The course of the vertical vein is vital with regard to obstruction in patients with supracardiac TAPVC. Usually, the vertical vein ascends anteriorly to the left pulmonary artery and the left bronchus, which is not obstructed. However, it may be obstructed when it passes between the left bronchus posteriorly and the left pulmonary artery anteriorly, the so-called ‘‘vise location’’ [1, 2]. Recent imaging methods such as MDCT and magnetic resonance angiography are useful for preoperative patients with TAPVC. Because echocardiography has a limited field of view for assessing peripheral pulmonary veins, we prefer MDCT for preoperative imaging, which requires less time for image acquisition [3]. In the current case, MDCT