Definitive Diagnosis of Obstructed Total Anomalous Pulmonary Venous Drainage in a Critically Ill Newborn With High-Resolution Computed Tomography
Anewborn infant (39 weeks’ gestation, birth weight 2.9 kg) was transferred urgently to our hospital with a transcutaneous oxygen saturation of 40% and a clinical suspicion of obstructed pulmonary venous return. Detailed cardiac ultrasound showed several large muscular ventricular septal defects with right to left shunting and a collecting vein behind the left atrium; however, the pulmonary venous anatomy was not clearly delineated. In particular, both the superior and inferior caval veins were enlarged, but the drainage pattern of all 4 pulmonary veins could not be visualized adequately.
Because cardiac catheterization was regarded as hazardous and urgent surgery was required in this critically ill baby, we performed cardiac computed tomography scanning with a LightSpeed VCT (GE, Milwaukee, Wisc) (slice thickness 0.625 × 64 mm, speed rotation 0.4 s, pitch 0.9, 80 kV, mA modulated during the acquisition, after peripheral injection of contrast agent [Iohexol 300 mgI/mL, volume of 1.5 mL/kg, flow rate of the injection of 1 mL/s]). The acquisition lasted 1 s, and the examination lasted an approximate total of 15 minutes.
Figures 1 through 3⇓⇓ demonstrate that all 4 pulmonary veins drained to a posterior collecting vein before draining via a tight stenosis to the infradiaphragmatic vena cava. Successful operative repair (with pulmonary artery banding for the ventricular septal defects) was carried out immediately after computed tomography scanning.
Obstructed total anomalous pulmonary venous drainage is a surgical emergency in newborns. These images highlight the potential diagnostic utility of high-resolution computed tomography scanning in this clinical situation.
The online-only Data Supplement, consisting of a movie, is available with this article at http://circ.ahajournals.org/cgi/content/full/114/25/e646/DC1.