1) A 24-day-old neonate presented with cyanosis since birth and difficulty breathing. Echocardiography showed supracardiac total anomalous pulmonary venous return with vertical vein obstruction. 2) The baby underwent vertical vein stenting under local anesthesia to treat the obstruction. 3) Follow-up echocardiography after the procedure showed improvement, with stents in the vertical vein and only mild tricuspid regurgitation. The procedure successfully treated the vertical vein obstruction.

1. Supracardiac TAPVR
Vertical vein obstruction
Dr. Abdul Ahad
Trainee Fellow Paeds Cardiology
Liaqat National Hospital Karachi

2. Case presentation
• 24 days neonate, product of consangious marriage presented with
chief complaint of;
Cyanosis since birth 3rd day of life
Difficulty in breathing since 3rd day of life
• Term delivery at periphery hospital via SVD. Normal antenatal scans
• At 5th day of life was admitted in hospital where
echocardiography was done, which showed small ASD with L to
R shunt, severe PPHN, mildly dilated RV, EF 64%.

3. HOPC
• History of one sibling death at 2nd month of life due to pneumonia
• All anthropometric measurement between 25th -50th percentile.
• All vitals were normal except for SpO2 80%.
• Central and peripheral cyanosis present.
• S1+S2( P2 loud), no murmur audible. Rest of exam unremarkable.

4. Hospital course
• Repeat Echocardiography showed: Supracardiac TAPVR with vertical
vein obstruction. Moderate size ASD secundum.Dilated right atrium
and ventricle. Severe tricuspid regurgitation 97 mmHg. LVEF 67%.
• Other laboratory investigation were in normal limits.
• Baby admitted in NICU for vertical vein stenting.

8. Procedure: Vertical vein stenting under Local
anesthesia

11. Post procedure
• Baby shifted to NICU for further management
• OG feed started after 2 hours of procedure
• Next day echocardiography done.
• It showed: Supracardiac TAPVR with vertical vein stents, Moderate
size ASD secundum, Dilate RA and RV, mild TR 30 mmHg, LVEF 70%
and normal RV function.

14. Thanks