pediatrics
Total Anomalous Pulmonary Venous Return (TAPVR)
Symptoms and Signs of TAPVR
Neonates with obstructed pulmonary venous return present with respiratory distress, pulmonary edema, and marked cyanosis. Physical examination usually shows a parasternal lift and a single, loud second heart sound (S2), with no significant murmur. If pulmonary venous return is not obstructed, mild symptoms of Heart failure may be present. Some infants with unobstructed supracardiac or cardiac total anomalous pulmonary venous return may be asymptomatic. Physical examination detects a hyperdynamic precordium, a widely split S2 sometimes with a loud pulmonary component, and a grade 2 to 3/6 systolic ejection murmur audible along the left sternal border (see table). A mid-diastolic tricuspid flow murmur may be audible at the lower left sternal border. 