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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
  • Ayşegül Karahan Zor,
  • Resmiye Beşikçi,
  • omer aydıner
Ayşegül Karahan Zor
Anadolu Medical Center

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Resmiye Beşikçi
Anadolu Medical Center
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omer aydıner
Istanbul Doctor Lufti Kirdar Kartal Training and Research Hospital
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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