Range-gated pulsed Doppler echocardiographic diagnosis of supracardiac total anomalous pulmonary venous drainage.

Three patients with total anomalous pulmonary venous drainage (TAPVD) into the innominate vein were studied by using M-mode and pulsed Doppler echocardiography. An abnormal continuous flow towards the transducer in a suprasternal notch position detected by pulsed Doppler echocardiography in the left hemithorax leftward of the aortic echo is a sign of blood flow through the left vertical vein into the innominate vein. This finding is highly specific for TAPVD. High-velocity flow across the tricuspid valve, disturbed flow in the right pulmonary artery and abnormal flow in the left atrium are additional important pulsed Doppler echocardiographic findings in TAPVD. Right ventricular enlargement and paradoxical interventricular septal motion by M-mode echocardiography were not specific enough to distinguish TAPVD from other right ventricular volume overload lesions. An echo-free space posterior to the left atrium was not recorded.