A Modified Suprasternal Approach in Transthoracic Echocardiography for
Detection of Isolated Left Upper Partial Anomalous Pulmonary Venous
Connection with Intact Atrial Septum: Hard to Diagnose, Easy to Miss
Abstract
BACKGROUND Isolated left upper partial anomalous pulmonary venous
connection (PAPVC) via innominate vein to the right atrium with intact
atrial septum is a rare congenital anomaly. Diagnosis requires a high
degree of suspicion, otherwise it may remain undetected. This study was
undertaken to determine the efficacy of a modified suprasternal view in
transthoracic echocardiography (TTE) for the detection of left upper
PAPVC. METHODS After diagnosis of left upper PAPVC in our first patient
incidentally in 2008, we have added the modified suprasternal view to
all TTEs performed in our pediatric cardiology clinic. This was obtained
by tilting the tail of the probe 30-45 degrees towards the right
shoulder of the patient during suprasternal long axis for a better view
of the innominate vein and search for left upper PAPVC. RESULTS Among
7200 patients who underwent TTEs between 2008-2020, we have identified
13 patients with left upper PAPVC into the innominate vein by using our
modified suprasternal approach. All were asymptomatic children, aged
between 5 months and 16 years. In all patients, cardiac chambers were
normal in size and there were no accompanying congenital disorders. In
10 cases, diagnoses were confirmed by multi-slice computerized
tomography, whereas one patient underwent catheterization for
confirmation. CONCLUSION Isolated left upper PAPVC to innominate vein
with intact atrial septum is a rare congenital disorder and can be
present in asymptomatic children with normal cardiac chambers. TTE, with
a modified approach in suprasternal long axis view, has a high
diagnostic value in the detection of this condition