Key points in the diagnosis of partial anomalous pulmonary venous connections using echocardiography and analysis of misdiagnosis and missed diagnosis

JIANG Yang; GAO Defen; ZHU Shanliang; YANG Ming; WANG Yaping; CHEN Jun

doi:10.20258/j.cnki.1006-9011.2025.11.012

Abstract：Objective To investigate the clinical value of echocardiography in diagnosing partial pulmonary venous connec-tion anomaly(PAPVC),to analyze the causes of missed and misdiagnosis.Methods The clinical data of 183 cases of PAPVC confirmed by surgery or CTA were selected,and the preoperative echocardiographic features were compared and analyzed with the CTA or surgical findings,and in-depth analyses were performed for the missed diagnosis,misdiagnosis,and subtyping,and the key points of echocardiographic diagnosis of this disease,and diagnostic techniques for different subtypes were summarized.Results Among 183 children with PAPVC,58.5%(107/183)were supracardiac,36.6%(67/183)were intracardiac,3.3%(6/183)were subcardiac,and 1.6%(3/183)were mixed.The echocardiographic diagnosis was correct in 158 cases,with a diag-nostic compliance rate of 86.3%,21 cases were missed,and 4 cases were misdiagnosed,with a rate of 13.7%.11 cases were missed due to the combination of multiple congenital cardiac malformations and neglect of pulmonary vein scanning,5 cases were missed due to heavy lung gas,which could not be clearly shown the traveling shape of each pulmonary vein,4 cases were missed due to insufficient knowledge of the disease,and 1 case was missed because the child was too old for subxiphoid.Among the 4 cases of misdiagnosis,3 cases of intracardiac PAPVC were misdiagnosed as secondary foramen ovale septal defect and 1 case of supracardiac PAPVC was misdiagnosed as left atrial main vein.Conclusions Echocardiography has an important diag-nostic value for PAPVC.Meanwhile,analyzing the reasons for missed diagnosis and misdiagnosis is necessary to improve the di-agnostic accuracy of this disease,which has an important clinical value for the timing and method of surgery as well as the assess-ment of patients'prognosis,thereby avoiding secondary surgery for patients.