Total anomalous pulmonary venous connection physical examination

Associate Editor-In-Chief:; Keri Shafer, M.D. [mailto:kshafer@bidmc.harvard.edu] Priyamvada Singh, MBBS mailto:psingh@perfuse.org

Assistant Editor-In-Chief: Kristin Feeney, B.S. mailto:kfeeney@perfuse.org

Overview- The physical finding depends on the degree of obstruction and the degree of left-to-right shunting.

The physical examination in patients with total anomalous pulmonary venous connection depends on the following factors-


 * Type of anatomic connection present between systemic and pulmonary venous circulation
 * Degree of obstruction
 * Type of obstruction (obstructed, unobstructed)
 * Amount of right to left shunting

Physical Examination
General Physical examination


 * Cyanosis (right to left shunt)
 * Decreased pulses (low systemic blood flow)
 * Hypotension (low systemic blood flow)
 * Tachypnea (right sided volume overload)
 * Hepatomegaly, peripheral edema (right sided heart failure)

Cardiovascular examination

Inspection


 * Precodial asymmetry indicating right ventricular hypertrophy

Palpation


 * Right ventricular heave

Auscultation


 * Prominent, Fixed split second heart sound (S2)
 * S3 gallop
 * Systolic ejection murmur at left upper sternal border
 * Diastolic murmur due to tricuspid regurgitation