Last, let's go through Total Anomalous Pulmonary Venous Return.
Here on the left side of your slide, you can see a normal heart.
On the right side of your slide, we're looking at a total anomalous pulmonary venous return.
I think this image might look confusing to you at first,
so I want to walk you through what exactly is happening.
The blood then comes back from the lungs
through that very red-looking pulmonary vein
into the superior vena cava.
It's not going back to the left atrium like it's supposed to.
This is totally anomalous.
That blood then goes back to the right atrium,
back to the right ventricle, out to the lungs again.
You can see we have a problem.
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.
Now, the blood returns, crosses into that atria,
goes to the left ventricle, and out to the body.
You can see why these patients are cyanotic at birth.
There's a lot of mixing of blood.
The right-sided blood is mixing with the left-sided blood
before it goes out to the body.
In these patients, the blood can return to a number of different places
and it can be truly remarkable.
About 50 percent of the time, the blood is like this picture -
it comes back to a supercardiac location from the pulmonary system.
About 20 percent of the time, the blood can be infracardiac
coming into the inferior vena cava.
20 percent of the time, the blood can come directly back into the heart
but in the wrong spot, usally the right atrium.
Or it can be mixed - it can be any of the above.
Sometimes the blood can even come back into the liver.
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.
These patients will undergo a complicated surgical repair
to try and get them more back to an appropriate cardiac physiology.
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.
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.
One is truncus and you can see my thumb is a trunk
coming off the main mixing of the right and left ventricles.
Next is transposition and you can see I've taken my two great vessels and I've mixed them together.
Next is tricuspid atresia.
Next is tetralogy of Fallot.
And the last one is total anomalous pulmonary venous return.
So that's a good trick to try and remember the five types of cyanotic heart disease.
That's very likely to show up on your test.
Also, remember those four findings in the tetralogy of Fallot.