test 6 Total Anomalous Pulmonary Venous Return (TAPVR) classifications Flashcards
1
Q
Total Anomalous Pulmonary Venous Return (TAPVR) classifications
A
- Supracardiac
- Cardiac
- Infracardiac
- Mixed
2
Q
Supracardiac TAPVR (Type I)
A
• Most common 52%
• Pulmonary Veins drain:
Vertical vein → Lt Brachiocephalic→ SVC
3
Q
What you see on an x-ray for Supracardiac TAPVR (Type I)
A
- Dilated SVC + Lt vertical vein (snowman heart)
- ↑ Vasculature
- ↑ RV volume
4
Q
Intracardiac TAPVR (Type II)
A
- 2nd most common
- Drains into coronary sinus or RA
- Increased pulmonary vasculature
- RV overload
- Only 20% of I and II TAPVR survive to adults (the rest die in 1st year)
5
Q
Infracardiac TAPVR (Type III)
A
- Long pulmonary veins course down the esophagus
- EMPTY IN PORTAL or IVC
- Veins constricted thru diaphragm (obstructive)
- Severe CHF (obstructive)
- Associated w/asplenia
- Death in a few days
6
Q
Mixed TAPVR
A
- All encompassing mix of whatever does not fit in the other classes
- Severity can vary significantly
7
Q
Obstructive TAPVR
A
- The severity of this condition depends on whether the pulmonary veins are obstructed
- In obstructed TAVPR, the pulmonary veins run into the abdomen, passing through the diaphragm.
- This squeezes the veins and narrows them, causing the blood to back up into the lungs (RA, RV pressures increase).
- Causes symptoms early - deadly if not recognized and surgically corrected.
8
Q
Obstructed TAPVR characteristics
A
- Pulmonary venous hypertension & secondary PA & RV hypertension
- Less RV and PA volume overload
- Pulmonary venous edema
- More cyanosis and respiratory distress
- Complete mixing
9
Q
NON-Obstructed TAPVR characteristics
A
- Similar hemodynamics to a large ASD
- L → R shunt magnitude is determined by RV compliance and ASD size
- Rt heart and pulmonary volume overload
- Complete mixing at RA level
- Minimal cyanosis due to large PBF
- Slight PA pressure elevation
