A modified suprasternal approach in transthoracic echocardiography for isolated left upper partial anomalous pulmonary venous connection: Hard to diagnose, easy to miss.

BACKGROUND

Isolated left upper partial anomalous pulmonary venous connection (PAPVC) via the innominate vein to the right atrium is a rare congenital anomaly. 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 the incidental diagnosis of left upper PAPVC in our first patient in 2008, we added a modified suprasternal view to all TTEs performed in our pediatric cardiology clinic. This was obtained by tilting the tail of the probe 30-450 towards the right shoulder of the patient during suprasternal long axis view for a better visualization of the innominate vein.

RESULTS

Among 7200 patients who underwent TTEs between 2008 and 2020, we identified 13 patients with left upper PAPVC into the innominate vein. All were asymptomatic children with normal cardiac chambers and 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 the innominate vein is a rare congenital disorder that 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.