In TAPVR, which view(s) can reveal an anomalous venous connection?

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In TAPVR, the pulmonary veins do not drain into the left atrium, so the path of venous return from the lungs is abnormal. The four-chamber view is the most direct window to this problem because it lets you see the left atrium and the pulmonary venous confluence as it should connect—or fail to connect—to the left atrium. When TAPVR is present, you often notice that the pulmonary veins do not enter the left atrium in the expected way, and a distinct anomalous venous channel or vertical vein may be seen coursing toward a systemic connection (for example to a superior vena cava or other conduit). Color Doppler can highlight the abnormal flow into the right-sided chambers, confirming the misrouting.

The three-vessel/trachea view is excellent for assessing the relationships of the great vessels and the outflow tracts, and it can raise suspicion of TAPVR in some cases, but it is less reliable for directly showing the actual anomalous venous connection from the pulmonary venous confluence. Therefore, the four-chamber view is the best single view to reveal an anomalous venous connection in TAPVR.