Pediatric Radiology

, Volume 42, Issue 6, pp 758–760 | Cite as

Cyanosis in a 9-month-old child after repair of total anomalous pulmonary venous return

  • Heiner LatusEmail author
  • Tarique Hussain
  • Thomas Krasemann
  • Gerald F. Greil
Case Report


A 9-month-old girl presented with cyanosis after correction of total anomalous pulmonary venous return (TAPVR) to the coronary sinus in the neonatal period. During corrective surgery, the right superior vena cava (RSVC) was damaged and re-anastomosed to the right atrium. Echocardiography showed increased flow velocity in the pulmonary venous confluence. Therefore, pulmonary venous obstruction was suspected. However, subsequent cardiac MRI revealed a stenosed RSVC as well as a dilated left superior vena cava (LSVC) draining from the left innominate vein into the pulmonary venous confluence. The re-recruited LSVC drained deoxygenated blood into the systemic circulation, causing cyanosis. After uncomplicated placement of a stent in the narrowed RSVC and occlusion of the LSVC, transcutaneous saturations normalised immediately.


Congenital heart disease Magnetic resonance imaging Anomalous pulmonary venous return Paediatric cardiac surgery 

Supplementary material

Movie 1

Three-dimensional keyhole imaging of the arterial and venous systems. After injection of gadolinium diethylenetriamine penta-acetic acid (Gd-DTPA), the venous phase is imaged with a 3D keyhole technique using maximum intensity projection (MIP) in the anterior-posterior direction (acquisition time, 1.9 s for each 3D dataset; resolution, 2 [overcontiguous slices] × 1 × 1 mm). The venous phase shows the drainage through the reopened left superior vena cava to the left atrium (AVI 8625 kb)

Movie 2

Three-dimensional keyhole imaging of the arterial and venous systems. Same as Movie 1 but the whole 3D dataset is spinning 360 degrees after injection of Gd-DTPA. Using MIP, the venous phase shows the drainage through the reopened LSVC to the left atrium (AVI 32328 kb)


  1. 1.
    Hyde JA, Stümper O, Barth MJ et al (1999) Total anomalous pulmonary venous connection: outcome of surgical correction and management of recurrent venous obstruction. Eur J Cardiothorac Surg 15:735–740PubMedCrossRefGoogle Scholar
  2. 2.
    Hancock Friesen CL, Zurakowski D, Thiagarajan RR et al (2005) Total anomalous pulmonary venous connection: an analysis of current management strategies in a single institution. Ann Thorac Surg 79:596–606PubMedCrossRefGoogle Scholar
  3. 3.
    Butler E (1927) The relative role played by the embryonic veins in the development of the mammalian vena cava posterior. Am J Anat 39:267CrossRefGoogle Scholar
  4. 4.
    Krishnamurthy R, Slesnick T, Browne L et al (2010) Free breathing high temporal resolution time resolved contrast enhanced MRA (4D MRA) at high heart rates using keyhole SENSE CENTRA in congenital heart disease. J Cardiovasc Magn Reson 12:33–34CrossRefGoogle Scholar
  5. 5.
    Filippini LH, Ovaert C, Nykanen DG et al (1998) Reopening of persistent left superior caval vein after bidirectional cavopulmonary connections. Heart 79:509–512PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Heiner Latus
    • 1
    • 3
    Email author
  • Tarique Hussain
    • 1
    • 2
  • Thomas Krasemann
    • 1
  • Gerald F. Greil
    • 1
    • 2
  1. 1.Department of Paediatric CardiologyEvelina Children’s HospitalLondonUnited Kingdom
  2. 2.Division of Imaging SciencesKing’s College LondonLondonUnited Kingdom
  3. 3.Division of Imaging SciencesThe Rayne Institute, King’s College LondonLondonUnited Kingdom

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