I read the article by Magalhães et al.1 published in the Portuguese Journal of Cardiology entitled “Anomalous pulmonary venous connection: an underestimated entity” with great interest.

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart defect consisting of anomalous connection of the pulmonary veins to the systemic veins. It is crucial whether there is an obstruction at the site of connection, which determines the clinical presentation of TAPVC in the neonatal period. An infant with obstructed TAPVC usually presents with marked respiratory distress, cyanosis, and metabolic acidosis. Immediate relief of the obstruction is required and, even with surgical intervention, the reported mortality is 5-7%.2 Especially in patients who are not suitable for open heart surgery due to poor condition or low birth weight, preoperative stabilization by temporarily relieving the obstruction may improve outcomes in this population. When corrective surgery needs to be delayed, atrial septostomy is one option to relieve pulmonary venous drainage. On the other hand, in addition to atrial septostomy, treatment of obstruction via balloon angioplasty and stent placement may be another method to restore pulmonary venous drainage.2–4 Moreover, in the low birth weight neonate, percutaneous balloon angioplasty or stent placement may be the only therapeutic options.