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Helical CT Angiography and Three-Dimensional Reconstruction of Total Anomalous Pulmonary Venous Connections in Neonates and Infants

¹ Department of Radiology, Sejong Heart Institute, 91-121 Sosa-dong, Sosa-gu, Pucheon, Kyunggi-do 422-232, 7-206 3rd St., South Korea.
² Department of Radiology, Inha University Hospital, Shinheung-dong, Choong-ku, Inchon, 400-103, South Korea.
³ Department of Pediatrics, Sejong Heart Institute, Sosa-gu, Pucheon, Kyunggi-do 422-232, South Korea.
⁴ Department of Cardiovascular Surgery, Sejong Heart Institute, Sosa-gu, Pucheon, Kyunggi-do 422-232, South Korea.

View larger version (131K): [in a new window]   Fig. 1A. —Total anomalous pulmonary venous connection to left innominate vein in 2-week-old male neonate. Axial CT scans show four separate pulmonary veins (arrows, B and C). Note streak artifact at right superior vena cava (black star, A) due to high concentration of contrast material injected via right antecubital vein.

View larger version (84K): [in a new window]   Fig. 1B. —Total anomalous pulmonary venous connection to left innominate vein in 2-week-old male neonate. Axial CT scans show four separate pulmonary veins (arrows, B and C). Note streak artifact at right superior vena cava (black star, A) due to high concentration of contrast material injected via right antecubital vein.

View larger version (79K): [in a new window]   Fig. 1C. —Total anomalous pulmonary venous connection to left innominate vein in 2-week-old male neonate. Axial CT scans show four separate pulmonary veins (arrows, B and C). Note streak artifact at right superior vena cava (black star, A) due to high concentration of contrast material injected via right antecubital vein.

View larger version (83K): [in a new window]   Fig. 1D. —Total anomalous pulmonary venous connection to left innominate vein in 2-week-old male neonate. Multiplanar reformatted image shows four pulmonary veins joining to form confluence posterior to left atrium, which connects to left innominate vein via vertical vein (V). A = aorta, P = pulmonary artery.

View larger version (90K): [in a new window]   Fig. 1E. —Total anomalous pulmonary venous connection to left innominate vein in 2-week-old male neonate. Shaded surface-display image shows vertical vein (V) draining into innominate vein. A = aorta, P = pulmonary artery.

View larger version (137K): [in a new window]   Fig. 2A. —Total anomalous pulmonary venous connection to right superior vena cava in 3-day-old female neonate with right isomerism, complete atrioventricular septal defect, patent ductus arteriosus, and right aortic arch. Axial CT scan shows vertical vein (v), which connects to right superior vena cava (RS). Patent ductus arteriosus (arrowhead) connects from inferior aspect of right aortic arch to proximal portion of right pulmonary artery (not shown).

View larger version (111K): [in a new window]   Fig. 2B. —Total anomalous pulmonary venous connection to right superior vena cava in 3-day-old female neonate with right isomerism, complete atrioventricular septal defect, patent ductus arteriosus, and right aortic arch. Shaded surface display-images show that four pulmonary veins form common pulmonary trunk, which connects to right superior vena cava (SVC, B) via vertical vein (V, B). Patent ductus arteriosus (d, C) connects to proximal portion of right pulmonary artery (rpa, C). lpa = left pulmonary artery, Ao = aorta.

View larger version (132K): [in a new window]   Fig. 2C. —Total anomalous pulmonary venous connection to right superior vena cava in 3-day-old female neonate with right isomerism, complete atrioventricular septal defect, patent ductus arteriosus, and right aortic arch. Shaded surface display-images show that four pulmonary veins form common pulmonary trunk, which connects to right superior vena cava (SVC, B) via vertical vein (V, B). Patent ductus arteriosus (d, C) connects to proximal portion of right pulmonary artery (rpa, C). lpa = left pulmonary artery, Ao = aorta.

View larger version (101K): [in a new window]   Fig. 3A. —Total anomalous pulmonary venous connection to coronary sinus in 6-week-old female infant with atrial septal defect, ventricular septal defect, and patent ductus arteriosus. Multiplanar reformatted image shows four pulmonary veins (v) that form confluence (cv) posterior to left atrium.

View larger version (91K): [in a new window]   Fig. 3B. —Total anomalous pulmonary venous connection to coronary sinus in 6-week-old female infant with atrial septal defect, ventricular septal defect, and patent ductus arteriosus. Maximum-intensity-projection images show no direct communication between confluent pulmonary venous chamber (cv, B) and left atrium (la, B). Confluent pulmonary venous chamber drains into coronary sinus (CS, C). Size of left atrium and ventricle (LV) is small. i = inferior vena cava, RA = right atrium, RV = right ventricle.

View larger version (101K): [in a new window]   Fig. 3C. —Total anomalous pulmonary venous connection to coronary sinus in 6-week-old female infant with atrial septal defect, ventricular septal defect, and patent ductus arteriosus. Maximum-intensity-projection images show no direct communication between confluent pulmonary venous chamber (cv, B) and left atrium (la, B). Confluent pulmonary venous chamber drains into coronary sinus (CS, C). Size of left atrium and ventricle (LV) is small. i = inferior vena cava, RA = right atrium, RV = right ventricle.

View larger version (108K): [in a new window]   Fig. 3D. —Total anomalous pulmonary venous connection to coronary sinus in 6-week-old female infant with atrial septal defect, ventricular septal defect, and patent ductus arteriosus. Shaded surface—display image shows vertical vein (V) connecting to coronary sinus (cs). i = inferior vena cava, ra = right atrium, RV = right ventricle, LV = left ventricle.

View larger version (89K): [in a new window]   Fig. 4A. —Total anomalous pulmonary venous connection to portal vein in 3-day-old male neonate with atrial septal defect and patent ductus arteriosus. Tip of umbilical venous catheter through inferior vena cava from umbilical vein is positioned in right atrium. Catheter from umbilical artery is positioned in aorta. Severe streak artifact by catheter containing high concentration of contrast material distorts right upper pulmonary vein (arrow, A). Vertical vein (v, B) is positioned anterior to descending thoracic aorta.

View larger version (95K): [in a new window]   Fig. 4B. —Total anomalous pulmonary venous connection to portal vein in 3-day-old male neonate with atrial septal defect and patent ductus arteriosus. Tip of umbilical venous catheter through inferior vena cava from umbilical vein is positioned in right atrium. Catheter from umbilical artery is positioned in aorta. Severe streak artifact by catheter containing high concentration of contrast material distorts right upper pulmonary vein (arrow, A). Vertical vein (v, B) is positioned anterior to descending thoracic aorta.

View larger version (84K): [in a new window]   Fig. 4C. —Total anomalous pulmonary venous connection to portal vein in 3-day-old male neonate with atrial septal defect and patent ductus arteriosus. Multiplanar reformatted image shows disrupted configuration in proximal portion of right upper pulmonary vein (arrow).

View larger version (66K): [in a new window]   Fig. 4D. —Total anomalous pulmonary venous connection to portal vein in 3-day-old male neonate with atrial septal defect and patent ductus arteriosus. Maximum-intensity-projection image shows four pulmonary veins and vertical vein (V) communicating with portal vein (P). Indistinct configuration is noted at proximal portion of left upper pulmonary vein and is due to motion-related and contrast-induced artifacts.

View larger version (82K): [in a new window]   Fig. 5A. —Total anomalous pulmonary venous connections to left superior vena cava and portal vein in 2-week-old male neonate with right isomerism, right aortic arch, dextrocardia, complete atrioventricular septal defect, double-outlet right ventricle, and pulmonary stenosis. Axial CT scans show that right pulmonary veins join to form common trunk (RPV, B), which passes anteriorly to trachea and inferiorly to aortic arch and drains into left superior vena cava (LS, A) with junctional stenosis (arrowhead, A).

View larger version (117K): [in a new window]   Fig. 5B. —Total anomalous pulmonary venous connections to left superior vena cava and portal vein in 2-week-old male neonate with right isomerism, right aortic arch, dextrocardia, complete atrioventricular septal defect, double-outlet right ventricle, and pulmonary stenosis. Axial CT scans show that right pulmonary veins join to form common trunk (RPV, B), which passes anteriorly to trachea and inferiorly to aortic arch and drains into left superior vena cava (LS, A) with junctional stenosis (arrowhead, A).

View larger version (87K): [in a new window]   Fig. 5C. —Total anomalous pulmonary venous connections to left superior vena cava and portal vein in 2-week-old male neonate with right isomerism, right aortic arch, dextrocardia, complete atrioventricular septal defect, double-outlet right ventricle, and pulmonary stenosis. On maximum-intensity-projection image, left pulmonary veins join to form another common trunk that is connected with compressed venous channel (arrowhead) between descending thoracic aorta and right atrium.

View larger version (115K): [in a new window]   Fig. 5D. —Total anomalous pulmonary venous connections to left superior vena cava and portal vein in 2-week-old male neonate with right isomerism, right aortic arch, dextrocardia, complete atrioventricular septal defect, double-outlet right ventricle, and pulmonary stenosis. Shaded surface-display images three-dimensionally display pulmonary veins and courses of anomalous venous drainage into systemic veins. Arrowheads indicate stenotic areas. LS = left superior vena cava, RPV = right pulmonary vein, LPV = left pulmonary vein, Ao = aorta.

View larger version (101K): [in a new window]   Fig. 5E. —Total anomalous pulmonary venous connections to left superior vena cava and portal vein in 2-week-old male neonate with right isomerism, right aortic arch, dextrocardia, complete atrioventricular septal defect, double-outlet right ventricle, and pulmonary stenosis. Shaded surface-display images three-dimensionally display pulmonary veins and courses of anomalous venous drainage into systemic veins. Arrowheads indicate stenotic areas. LS = left superior vena cava, RPV = right pulmonary vein, LPV = left pulmonary vein, Ao = aorta.

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