Clinical Report: Prenatal Risk Assessment of Pulmonary Venous Obstruction in TAPVR

Background

Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect that can lead to significant neonatal morbidity and mortality, particularly when pulmonary venous obstruction (PVO) is present. Accurate prenatal identification of PVO is challenging due to low fetal pulmonary blood flow, which can mask obstruction. Advances in fetal echocardiography and maternal hyperoxygenation techniques may improve the detection of PVO.

Data Highlights

Key Findings

• MHO testing can enhance the assessment of PVO risk in fetuses with TAPVR.
• Fixed anatomical obstructions may be revealed through disproportionate increases in vertical vein velocities during MHO.
• Preserved pulmonary vasoreactivity during MHO indicates a lower risk of severe PVO.
• Standard Doppler thresholds for assessing PVO may be limited under baseline fetal conditions.
• Initial clinical outcomes in neonates correlated with MHO findings.

Clinical Implications

The use of maternal hyperoxygenation during fetal echocardiography may provide insights into the risk of postnatal pulmonary venous obstruction in TAPVR cases.

Conclusion

Maternal hyperoxygenation may be an approach for evaluating the risk of pulmonary venous obstruction in fetuses diagnosed with TAPVR.

Related Resources & Content

1. Madan, A., Ultrasound in Obstetrics & Gynecology, 2024 -- Acute maternal hyperoxygenation protocol: consensus opinion from the Fetal Heart Society
2. Pediatric Cardiology, Maternal Hyperoxygenation for Prenatal Risk Stratification of Pulmonary Venous Obstruction in Total Anomalous Pulmonary Venous Return, 2024 -- Maternal Hyperoxygenation for Prenatal Risk Stratification of Pulmonary Venous Obstruction in Total Anomalous Pulmonary Venous Return
3. Pediatric Cardiology, Enhanced Materno-Fetal Oxygenation in Late Pregnancy May Benefit Hypoplastic Cardiac Structures Linked to Fetal Heart Defects, 2009 -- Enhanced Materno-Fetal Oxygenation in Late Pregnancy May Benefit Hypoplastic Cardiac Structures Linked to Fetal Heart Defects
4. Pediatric Cardiology, Assessing Fetal Pulmonary Venous Return: Bridging Basic Research and Clinical Doppler Applications, 2023 -- Assessing Fetal Pulmonary Venous Return: Bridging Basic Research and Clinical Doppler Applications
5. Pediatric Cardiology — Management of a Neonate with Heterotaxy and Single Ventricle Physiology Complicated by Pulmonary Atresia and Obstructed TAPVR
6. Pediatric Cardiology — Protrusion of Umbilical Vein Catheter into a Pulmonary Vein in a Patient with Infracardiac Total Abnormal Pulmonary Venous Drainage
7. Total Anomalous Pulmonary Venous Connections - PubMed
8. Multimodality Imaging in Presurgical Evaluation of Total Anomalous Pulmonary Venous Connection - PubMed
9. Maternal Hyperoxygenation for Prenatal Risk Stratification of Pulmonary Venous Obstruction in Total Anomalous Pulmonary Venous Return | Pediatric Cardiology | Springer Nature Link
10. Acute maternal hyperoxygenation protocol: consensus opinion from the Fetal Heart Society - Madan - 2024 - Ultrasound in Obstetrics & Gynecology - Wiley Online Library
11. Guidelines and Recommendations for Performance of the Fetal Echocardiogram: An Update from the American Society of Echocardiography
12. Fetal Cerebrovascular Response to Maternal Hyperoxia Testing and Association With Brain Growth and Postnatal Brain Injury in Congenital Heart Disease - PMC