Evaluation of infradiaphragmatic total anomalous pulmonary venous connection with two-dimensional echocardiography

In three newborn infants with infradiaphragmatic total anomalous pulmonary venous connection, the common pulmonary vein was visualized with two-dimensional echocardiography and validated with saline contrast injections. The transducer was placed in the subcostal region in a sagittal body plane so as to image the descending aorta and the vertebral column. The common pulmonary vein, which connected the pulmonary veins to a systemic vein in the abdomen, was seen lying parallel and anterior to the descending aorta and to the left of the inferior vena cava. With peripheral venous contrast injections, contrast echoes first filled the inferior vena cava and then the descending aorta because of obligatory right-to-left atrial shunting. The common pulmonary vein was the only structure that remained free of contrast echoes. Thus, contrast echocardiography provided a method for identifying the site of pulmonary venous drainage and for distinguishing the common pulmonary vein from other structures such as the inferior vena cava. In cyanotic infants with respiratory distress, two-dimensional contrast echocardiography permits a rapid diagnosis of infradiaphragmatic total anomalous pulmonary venous connection.