What is the principal prenatal echocardiographic sign of total anomalous pulmonary venous return (TAPVR)?

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What is the principal prenatal echocardiographic sign of total anomalous pulmonary venous return (TAPVR)?

Pulmonary veins that do not connect to the left atrium and instead drain into systemic venous pathways is the hallmark finding. In the fetus, this appears as an anomalous venous connection from the pulmonary venous confluence to the right‑sided circulation, often seen as a vertical vein coursing toward the superior vena cava or innominate vein on the three‑vessel/trachea view, and can also be seen in the four‑chamber view. Because the pulmonary venous return is redirected to the right heart, the left atrium is relatively small, and there is mixing of blood in the right atrium with an interatrial communication that allows systemic perfusion. This abnormal drainage pattern distinguishes TAPVR from normal pulmonary venous return, which enters the left atrium.

Pulmonary veins that do not connect to the left atrium and instead drain into systemic venous pathways is the hallmark finding. In the fetus, this appears as an anomalous venous connection from the pulmonary venous confluence to the right‑sided circulation, often seen as a vertical vein coursing toward the superior vena cava or innominate vein on the three‑vessel/trachea view, and can also be seen in the four‑chamber view. Because the pulmonary venous return is redirected to the right heart, the left atrium is relatively small, and there is mixing of blood in the right atrium with an interatrial communication that allows systemic perfusion. This abnormal drainage pattern distinguishes TAPVR from normal pulmonary venous return, which enters the left atrium.

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