Thread by @swatigar

1/n Once in a while, that new young child with a prior echo stating " primum asd" turns out to be something else...
I'll label this clip : " so far so good' #echofirst #CHD

2/n this is plax

3/n subcostal 4ch view. this one carries the label : "moment of truth? "

4/n diagnosis made?

5/n the arrow points to the real asd , shunting obligatorily right to left

6/n but wait there is more. .. this is a suprasternal view, showing the lupv draining correctly into the LA with mild turbulence!

7/n. So complete diagnosis: PAPVC with 3 pulm veins to coronary sinus ( typical tail of whale seen in clip 4, the right fin of the tail are the right sided veins and the left fin is the llpv) + lupv to LA.
Saturation was 92%
Benefitted from surgery ofcourse. Didn't have PH

8/n Moral of the story?
1. Precede every echo with physical exam ( saturation check is 4th vital sign)
2. Start with a fresh mind. Avoid reading prior echo report ( but definitely read it later so as to not miss something it picked up).
3. A simple asd in a child shouldn't have

n-1/n ...saturation below 95%
4. DD of dilated RA and RV in an infant or child is asd and also tapvc .
5. "Primum asd" diagnosis in a child with baseline desat.. .. always think of tapvc to coronary sinus as alternate diagnsosis.....
6. Look hard for another ( real) asd in

n/n.. such cases which will invariably shunt R to L.

Finally, don't be disheartened if u miss a TAPVC!

As My attending in fellowship used to say.. "There are 2types of cardiolgists... Those who have missed a tapvc and those who haven't missed it yet.