Supra cardiac is a term in congenital heart surgery and anatomy meaning ‘above the heart’. It is most commonly encountered in the classification of total anomalous pulmonary venous drainage (TAPVD), a rare but serious congenital heart condition in which the pulmonary veins (which normally carry oxygenated blood from the lungs to the left atrium) instead connect abnormally to a systemic vein.
TAPVD is classified by the site of the anomalous connection. In supra cardiac TAPVD (the most common type, approximately 50% of cases), the pulmonary veins drain above the heart via a vertical vein that connects to the superior vena cava (SVC) or a brachiocephalic vein. In cardiac TAPVD, the pulmonary veins connect to the coronary sinus or directly to the right atrium. In infra cardiac TAPVD, the connection is below the heart (to the portal or hepatic vein). Mixed TAPVD involves a combination of connection levels.
In all types of TAPVD, oxygenated blood from the lungs enters the right side of the heart rather than the left. Survival depends on the presence of a communication (typically an atrial septal defect) allowing some oxygenated blood to reach the systemic circulation. TAPVD is a neonatal surgical emergency requiring urgent repair in the first days to weeks of life.
Adults who have had TAPVD repair may have residual abnormalities and should be followed up in adult congenital heart disease (ACHD) specialist services.
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