Fig. 28.1
Diagrammatic representation of supracardiac totally anomalous pulmonary venous return. The pulmonary veins drain to a left vertical vein that then connects to the innominate vein. The color scheme demonstrates the level of blood oxygenation in various parts of the heart. The blood is red (normal oxygen saturation) in the pulmonary veins and in the vertical vein. As it mixes with the systemic venous return blood, it becomes blue (low oxygen saturation) (Reproduced or adapted from Driscoll, David Fundamentals of Pediatric Cardiology, Lippincott Williams & Wilkins, 2006, with permission of the author and publisher)
28.2 Pathologic Physiology
Instead of connecting to the left atrium, the pulmonary veins connect to the systemic venous system. Consequently, pulmonary venous blood returns to the right atrium instead of to the left atrium. The locations of the connection of the pulmonary veins to the systemic veins (in order of frequency) are: the left vertical vein, innominate vein, coronary sinus, right atrium, umbilicovitelline system (portal vein, ductus venosus, inferior vena cava, hepatic vein), and superior vena cava. In “mixed” total anomalous pulmonary venous return, a combination of the above might occur. For example, the left pulmonary veins may connect to the left vertical vein and the right pulmonary veins directly to the right atrium. Because there is no direct communication between the pulmonary veins and the left atrium, a communication must exist between the right atrium and left atrium to allow blood to reach the left atrium and the left ventricle. Relatively complete mixing of the systemic and pulmonary venous returns occurs in the right atrium such that blood oxygen saturations in the right atrium, left atrium, right ventricle, pulmonary artery, left ventricle, and aorta are similar.
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