Summary Page Total Anomalous Pulmonary Venous Return

1. Supracardiac-type TAPVC. Anomalous vein returning pulmonary venous blood from the lungs to the superior vena cava.
2. Confluence of pulmonary veins behind, but not connected to the left atrium.
3. Atrial septal defect allows blood flow to left atrium.
4. ASD patched.
5. Anomalous pulmonary venous connection divided.
6. Pulmonary vein confluence attached to left atrium.
7. Intracardiac-type TAPVC. Pulmonary vein confluence draining to right atrium via enlarged coronary sinus.
8. Infracardiac-type TAPVC. Pulmonary venous blood draining through the liver to reach the IVC and right atrium.

The pulmonary veins join together in a confluence but do not attach normally to the left atrium. Instead, pulmonary venous blood is directed to the right atrium by one of three routes.

Supracardiac-type TAPVC: Blood drains from the pulmonary veins to the superior vena cava system via an anomalous "vertical vein".

Intracardiac-type TAPVC: Blood drains from the pulmonary veins to the right atrium directly via the coronary sinus, the vein that normally only drains the coronary veins of the heart muscle itself.

Infracardiac-type TAPVC: Blood drains from the pulmonary veins to the right atrium via a vertical vein that passes inferiorly through the diaphragm. This blood must then pass through the liver to reach the IVC. This pathway often causes obstruction to flow.

Repair consists of:

• Attachment of the pulmonary vein confluence to the left atrium.
• Division of the anomalous connection to the right side of the heart.
• Closure of the ASD.