ABSTRACT
Introduction Prenatal diagnosis of abnormal pulmonary venous connections is considered very challenging for an obstetric sonographer or sonologist and may also elude the fetal echocardiographer. Anomalies of the pulmonary veins are rarely detected in the fetus on second-trimester obstetric screening due to their low incidence and difficulty in obtaining detailed imaging.1 Over the last two decades, refinement in ultrasound technology and cumulative operator experience has helped improve recognition of these conditions. Case series of over a dozen cases from single center experiences began appearing in the early 2000s (including Valsangiacomo et al.2 and Patel et al.3). More recently, several centers have reported the potential for improvement in prenatal detection rates of pulmonary venous anomalies even with standard obstetric screening views.4-7 Most infants with partial anomalous pulmonary venous connection (PAPVC) will be asymptomatic early in life, but the condition does require surgical repair in order to preserve functional status later in life. Though a majority of infants with total anomalous pulmonary venous connection (TAPVC) will present with nonspecific respiratory symptoms or feeding issues and mild desaturation, the condition can be life threatening within minutes to hours of birth if the pulmonary venous drainage is obstructed, and in cases with associated cardiac abnormalities, anomalies of the pulmonary veins may greatly alter surgical approach and prognosis. Therefore, an understanding of these anomalies is of paramount importance, and timely, accurate prenatal diagnosis dictates that evaluation of the pulmonary veins should be part of any complete fetal cardiac evaluation.
