title: Anomalous Pulmonary Venous Return: Insights Into Prenatal Detection.
abstract: OBJECTIVE
  To review all cases of total anomalous pulmonary venous return (TAPVR) or partial anomalous pulmonary venous return (PAPVR) identified prenatally or postnatally at a single institution and to identify factors that may lead to a correct or missed diagnosis in both high- and low-risk fetuses on screening examinations.
  
  
  METHODS
  Fetal images from 16 cases of prenatally or postnatally diagnosed T/PAPVR were retrospectively reviewed to analyze factors that influenced interpretations and diagnoses.
  
  
  RESULTS
  Sixteen diagnoses of T/PAPVR were made, with a final number of 10 confirmed cases, 1 of which was PAPVR. Ten fetuses with a presumptive diagnosis of T/PAPVR before delivery were at an average gestational age of 24.7 weeks, with 5 cases diagnosed postnatally. None of the diagnoses of isolated TAPVR were made during a screening examination. Twelve of the pregnancies were complicated by complex cardiac defects, including 6 with heterotaxy syndromes. Of the 5 abnormal cases identified in the postpartum period, 3 had isolated TAPVR. In the 3 patients with isolated defects, prenatal echocardiography was not performed; the anatomy scan interpretations were confounded by multiple factors. In retrospect, there was no obvious sonographic evidence of TAPVR in these patients; however, color flow Doppler imaging of the pulmonary veins was not performed on any of them.
  
  
  CONCLUSIONS
  Although fetal echocardiography has improved the overall detection of TAPVR or PAPVR, this abnormality continues to elude prenatal diagnosis during screening in both low- and high-risk patients. We hypothesize that the use of color flow Doppler imaging in the 4-chamber view may assist in diagnosing TAPVR in screening low-risk patients, especially in those with difficult scans.
authors.affiliation: Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA.
authors.forename: Richelle
authors.initials: R
authors.lastname: Olsen
authors.affiliation: University of California San Diego Medical School, La Jolla, California USA.
authors.forename: Zoe
authors.initials: Z
authors.lastname: Doyle
authors.affiliation: Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADivision of Cardiology, Department of Pediatrics, Southern California Permanente Medical Group, Kaiser Permanente, San Diego, California USA.
authors.forename: Denis
authors.initials: D
authors.lastname: Levy
authors.affiliation: Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Anton
authors.affiliation: Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Pediatrics, University of California San Diego, San Diego, California USA.
authors.forename: Delaram
authors.initials: D
authors.lastname: Molkara
authors.affiliation: Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Reproductive Medicine, University of California San Diego, San Diego, California USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Tarsa
authors.affiliation: Department of Pediatrics, University of California Los Angeles, Los Angeles, California USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Sklansky
authors.affiliation: Department of Maternal-Fetal Care and Genetics, University of California San Diego, La Jolla, California USADepartment of Radiology, University of California San Diego, San Diego, California USA dpretorius@ucsd.edu.
authors.forename: Dolores H
authors.initials: DH
authors.lastname: Pretorius
mesh_terms: D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012587:Scimitar Syndrome / Q000000981:diagnostic imaging* / Q000196:embryology; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: anomalous pulmonary venous return; fetal echocardiography; partial anomalous pulmonary venous return; total anomalous pulmonary venous return