Antenatal diagnosis of isolated infracardiac infradiaphragmatic total anomalous venous connection - Pictorial essay and discussion.

Introduction: Antenatal diagnosis of isolated infracardiac total anomalous pulmonary venous connection (TAPVC) is rare. Making the diagnosis antenatally is critical as delayed management could result in neonatal deterioration and poor outcome after surgery.

Method: A multipara at 29 weeks of gestation was referred to our tertiary unit for ultrasound review. The fetal growth and biophysical profile were normal. A fetal echocardiogram revealed normal cardiac position with atrioventricular and ventriculoarterial concordance. There was a mild discrepancy in size of the right and left chambers of the heart. A connection between the pulmonary veins and the left atrium could not be established. A pulmonary venous confluence was noted posterior to the left atrium, from which a descending vertical vein emerged traversing the diaphragm and draining into the left portal vein into the liver.

Results: A diagnosis of infracardiac infradiaphragmatic total anomalous pulmonary venous connection was made. The pregnancy was delivered at 39 weeks by lower segment caesarean section. The antenatal findings were confirmed by postnatal echocardiogram. Successful sutureless repair of the pulmonary veins was performed.

Conclusion: Isolated infracardiac total anomalous pulmonary venous connection can be diagnosed antenatally. This ensures early postnatal evaluation and successful repair.