Anomalous Pulmonary Venous Return: Insights Into Prenatal Detection

Area of Science:

• Fetal Cardiology
• Medical Imaging
• Congenital Heart Defects

Background:

• Total anomalous pulmonary venous return (TAPVR) and partial anomalous pulmonary venous return (PAPVR) are serious congenital heart defects.
• Prenatal diagnosis of these conditions is crucial for timely intervention and improved outcomes.
• Screening examinations, even in high-risk fetuses, can miss these anomalies.

Purpose of the Study:

• To review cases of TAPVR/PAPVR diagnosed prenatally or postnatally.
• To identify factors contributing to accurate or missed diagnoses in screening examinations.
• To evaluate diagnostic challenges in both low- and high-risk fetuses.

Main Methods:

• Retrospective review of fetal images from 16 cases with diagnosed T/PAPVR.
• Analysis of factors influencing interpretation and diagnosis.
• Focus on screening examinations and their limitations.

Main Results:

• 10 confirmed cases of T/PAPVR (1 PAPVR) out of 16 diagnoses.
• No isolated TAPVR cases were diagnosed during routine screening.
• 5 cases diagnosed postnatally, 3 with isolated TAPVR missed prenatally due to lack of color Doppler and confounding factors.

Conclusions:

• Despite advancements, fetal echocardiography still struggles to detect TAPVR/PAPVR during screening.
• Isolated TAPVR is particularly difficult to diagnose prenatally.
• Color flow Doppler imaging in the 4-chamber view may enhance screening detection, especially in challenging scans.