• Supracardiac Total Anomalous Pulmonary Venous Return
  • Color Doppler demonstrating pulmonary veins draining an anomalous to a confluence
  • The pulmonary veins demonstrate normal laminar flow and do not appear to be obstruction as they drain into the confluence

• Supracardiac Total Anomalous Pulmonary Venous Return
  • Vertical vein ascends superiorly and drains into the innominate vein 

• Supracardiac total anomalous pulmonary venous return
  • Vertical vein ascends and drains into the innomminate vein
  • Vertical vein passes anterior to the left pulmonary artery 
    • Typically no obstruction if vertical vein passes anterior to left mainstem bronchus and left pulmonary artery
    • In some caes, vertical vein passes between left pulmonary artery and left mainstem bronchus causing pulmonary venous obstruction

• Supracardiac Total Anomalous Pulmonary Venous Return
  • Vertical vein ascends and drains into the innominate vein
  • Vertical vein flow becomes turbulent as it passes over the left pulmonary artery
    • Vertical vein travels between the left pulmonary artery and mainstem bronchus with compression causing pulmonary venous obstruction

• Supracardiac Total Anomalous Pulmonary Venous Return
  • Spectral Doppler in the vertical vein revealing obstruction along its course of the vertical vein
  • Obstruction most common as vertical vein passes between left pulmonary artery and left bronchus

Supracardiac Total Anomalous Pulmonary Venous Return

• Color compare sweep demonstrating an ascending vertical vein
• There appears to be obstuction as the vertical vein passes between the left pulmonary artery and left bronchus ("physiologic vice") with flow turbulence starting in this region
• The vertical vein ultimately drains into the left innominate vein which continues into the SVC seen at the end of this sweep

Supracardiac Total Anomalous Pulmonary Venous Return

• Color compare sweep demonstrating an ascending vertical vein
• There appears to be obstuction as the vertical vein passes between the left pulmonary artery and left bronchus ("physiologic vice") with flow turbulence starting in this region

Supracardiac Total Anomalous Pulmonary Venous Return

• Color Dopper in an ascending vertical vein
• There appears to be obstuction as the vertical vein passes between the left pulmonary artery and left bronchus ("physiologic vice") with flow turbulence starting in this region

Supracardiac Total Anomalous Pulmonary Venous Return

• Color compare view demonstrating two left and one right pulmonary vein (veins represented by stars) draining into a confluence with an ascending vertical vein 
• There appears to be obstuction as the vertical vein passes between the left pulmonary artery and left bronchus ("physiologic vice") with flow turbulence starting in this region