Infracardiac TAPVR

Case 1 - Infracardiac TAPVR

Total anomalous pulmonary venous connection: infracardiac to patent venous duct, obstructed with a peak gradient of 11 mmHg. One right and one left pulmonary venous trunks joining a confluence that drains in a vertical vein to the liver. Those trunks collect the right and left pulmonary veins. There is a small vein draining into a mildly dilated coronary sinus with pulmonary vein flow pattern that represents a supernumerary pulmonary vein. The ASD shunts right to left, as expected. The PDA is bidirectional with a right to left component in systole (peak gradient of 13 mmHg). The RA and RV are dilated. The septum is flat at peak of systole, indicating at least 2/3 systemic RV systolic pressure. 

Case 2 - Infracardiac TAPVR

Total anomalous pulmonary venous connection - infracardiac to patent venous duct. The PFO is right to left as expected. There is TR with RV-RA gradient of 81 mmHg. There is right ventricular dilation with reduced RV function by TAPSE and FAC. The LV is underfilled. There is a PDA that is bidirectional with a peak gradient right to left in systole of 20 mmHg.