How to Detect a Case with Total Anomalous Pulmonary Venous Connection by Fetal Screening?

The detection rate of total anomalous pulmonary venous connection (TAPVC) remains low (<5%) in spite of the current progress of fetal screening by advanced imaging technologies and guidelines. The several techniques has been reported as effective to detect TAPVC by using color Doppler or power Doppler, however these were limited to use at the routine fetal screening. The key to make a diagnosis of TAPVC by fetal echocardiography, is to detect an abnormal pulmonary venous chamber usually located between left atrium(LA) and descending aorta(DAo), which could not connect directly to a left atrium. One may use the ratio of a distance of LA-DAo;LD and a diameter of DAo;DA (post-LA index; Kawazu Y Ultrasound Obst Gynecol 2014) at routine four-chamber view. If this ratio (LD/DA) is > 1.27 on fetal screening, the risk of the presence of TAPVC became evident. Then more scrutinized fetal echocardiographic exmamination is provided to make a precise diagnosis of TAPVC by color and power Doppler imaging. The fetal diagnosis of TAPVC is more important in perinatal managements not only for avoiding emergency surgery but also for life-saving, if we could improve our detection rate.