Total Anomalous Pulmonary Venous Return (TAPVR)

00:02 Last, let's go through Total Anomalous Pulmonary Venous Return.

00:08 Here on the left side of your slide, you can see a normal heart.

00:13 On the right side of your slide, we're looking at a total anomalous pulmonary venous return.

00:19 I think this image might look confusing to you at first, so I want to walk you through what exactly is happening.

00:26 The blood then comes back from the lungs through that very red-looking pulmonary vein into the superior vena cava.

00:36 It's not going back to the left atrium like it's supposed to.

00:38 This is totally anomalous.

00:40 That blood then goes back to the right atrium, back to the right ventricle, out to the lungs again.

00:45 You can see we have a problem.

00:47 How is the blood going to get into the body? Well, it's going to blow through that patent foramen ovale that's between the two atria.

00:56 Now, the blood returns, crosses into that atria, goes to the left ventricle, and out to the body.

01:03 You can see why these patients are cyanotic at birth.

01:06 There's a lot of mixing of blood.

01:08 The right-sided blood is mixing with the left-sided blood before it goes out to the body.

01:12 In these patients, the blood can return to a number of different places and it can be truly remarkable.

01:23 About 50 percent of the time, the blood is like this picture - it comes back to a supercardiac location from the pulmonary system.

01:35 About 20 percent of the time, the blood can be infracardiac coming into the inferior vena cava.

01:41 20 percent of the time, the blood can come directly back into the heart but in the wrong spot, usally the right atrium.

01:49 Or it can be mixed - it can be any of the above.

01:54 Sometimes the blood can even come back into the liver.

01:58 So every patient with total anomalous pulmonary venous return is going to have a slightly different cardiac physiology that has to be fully understood before surgical repair can be made.

02:10 These patients will undergo a complicated surgical repair to try and get them more back to an appropriate cardiac physiology.

02:21 I'm going to close now with a trick, which will help you try to remember the types of cyanotic heart disease and it's easy if you just use your hand.

02:31 Remember, there are five types and I remember them like this, "One, two, three, four, five." I'll go through them one at a time.

02:41 One is truncus and you can see my thumb is a trunk coming off the main mixing of the right and left ventricles.

02:49 Next is transposition and you can see I've taken my two great vessels and I've mixed them together.

02:55 Next is tricuspid atresia.

02:58 Next is tetralogy of Fallot.

03:01 And the last one is total anomalous pulmonary venous return.

03:06 So that's a good trick to try and remember the five types of cyanotic heart disease.

03:11 That's very likely to show up on your test.

03:13 Also, remember those four findings in the tetralogy of Fallot.