 Myself Dr. Hemant Kumar Jeeya, PG resident from ABUNES and Dr. RML Hospital in New Delhi, I am going to present a paper on role of cardiac city in evaluation of anomalies of pulmonary veins and associated cardiac anomalies. And my guides are Dr. Munish Guleri as a red-doctor, Sonia Sandeep ma'am. Coming to the embryological basis, lung starts developing from 26 day of enteritis left during which venous drainage of the lung is to the systemic veins through pair of cardinal and umbilical veins. By 40 a day venous drainage of the lung loses the connection with the systemic veins as the envelope and starts draining to the left atrium through common pulmonary vein. This common pulmonary vein incorporates to the left atrium as the gestation advances to form four independent pulmonary veins. Failure of loss of communication of venous drainage of the lung with the systemic vein leads to various forms of anomalous pulmonary venous drainage depending on the number and location of the pulmonary vein involved. This is the coronal reformatted CT image showing the normal pulmonary venous drainage pattern in which the four independent pulmonary veins are draining into the left atrium. Coming to the aims, aim of our study was to analyze the anomalous pulmonary venous drainage spectrum and to detect the associated cardiac anomalies. Methodology, this was a cross-sectional observational study done in a patient's diagnosed with anomalies of pulmonary vein on echo or with the clinical suspicion of anomalies of pulmonary vein. The study was conducted in a tertiary care hospital, ABWIMS and Dr. RML Hospital, New Delhi, India during the period of June 2018 and August 2021. Image acquisition, retrospective ECG-Gated cardiac imaging was done in 128 slice CMS dual energy CT scanner. Coming to the results and discussion of our study, we had a total of 60 patients in our study out of which 44 patients had TAPVC, 4 patients had PAPVC, 7 patients had sinus venous defect, 1 patient had malposition of septum primum, 2 patients had congenital venolobar syndrome and 2 patients had cortriatrium. Among all the spectrum of anomalies of pulmonary vein, TAPVC was the most common pattern in our study and the malposition of septum primum was the least common type. Among 44 patients of TAPVC, supracardiac variant was the most common type which was seen in 52% of the cases followed by cardiac and mixed type of TAPVC. Supracardiac was the least common type of TAPVC which was seen in 6.8% of just cases. Coming to the drainage pattern of supracardiac TAPVC in which common chamber continuing as a vertical vein draining into the left brachiosophilic vein which in turn draining into the SVC was the most common pattern seen in 14 patients of supracardiac TAPVC. Common chamber continuing as a vertical vein draining into the SVC was seen in 5 patients. Common chamber continuing as a vertical vein draining into the inominate vein and the right-sided vein draining into SVC was seen in 2 patients. Common chamber draining into the right atrium via the left superior vena keva was seen in 1 patient. Right-sided vein draining into the asegas veins and the left-sided vein draining into inominate vein was seen in 1 patient. In the drainage pattern of cardiac TAPVC, most common pattern was seen was common chamber draining into the right atrium via the coronary sinus which was seen in 8 out of the 10 patients. Common chamber or pulmonary veins individually draining into the RA was seen in remaining 2 patients. Coming to the drainage pattern of infracardiac TAPVC, among the 3 patients of infracardiac TAPVC, common vertical vein draining into the confluence of portland spenic vein was seen in 2 patients. Common vertical vein draining into spenic vein was seen in 1 patient. In the drainage pattern of mixed TAPVC, left-sided vein draining into inominate vein and the right-sided vein draining into the coronary sinus and in turn draining into RA was the most common pattern which was seen in 7 out of the 8 patients of mixed TAPVC. In the right-sided vein draining into the RA, left-sided vein draining into the SVC was seen in 1 of the remaining patients. Coming to the partial anomalous pulmonary venous return, among the 4 patients of partial anomalous pulmonary venous return, we had 2 supracardiac and 2 cardiac TAPVC. In supracardiac drainage pattern was of right upper lobe veins draining to the SVC directly and in cardiac TAPVC, right-sided veins were draining to right atrium via the coronary sinus. Among the obstructed cases of TAPVC, we had 3 obstructed cases out of which 1 patient was supracardiac type and 2 patients were of infracardiac type. Among 23 of the total supracardiac cases, only 1 patient of supracardiac was obstructed, constituting the 4.3% of the cases and among the 3 patients of infracardiac TAPVC, 2 patients were of obstructed type which constituted the 66.6% of the cases of infracardiac TAPVC. Coming to the type of the shunt, among all the patients, we had ASD as the most common pattern of shunt which was seen in 96% of the cases, followed by the VSD which was seen in 16% of the cases and PDA which was the least common shunt and seen in 3.3% of the cases. Coming to the associated cardiac anomalies, persistent left superior vena keva was the most common associated cardiac anomaly which was seen in 12 patients, followed by pulmonary stenosis with or without the pulmonary artery hypoplasia which was seen in 7 patients and DOA RV which was seen in 4 patients. Other associated cardiac anomalies we have encountered are single common coronary trunk which was seen in 3 patients, complete AV canal defect seen in 2 patients, single lateral morphology seen in 1 patient, univentricular heart seen in 2 patients, co-op patient of Ayurveda with or without hypoplastic left heart syndrome was seen in 2 patients, transposition of great artery was seen in 1 patient, right-sided Ayurvedic arch was seen in 2 patients, arch was seen in 2 patients, azygous continuation of IVC was seen in 2 patients, deroofing of coronary sinus was also seen in 1 patient. Coming to the association of anomalous pulmonary venus written with the heterotaxis syndrome, we had 5 patients of heterotaxis syndrome amongst 60 cases, out of which 2 were of left-sided isomerism and 3 were right isomerism. One left isomerism patient had cardiac TAPVC with azygous continuation of IVC, another left isomerism patient had cardiac TAPVC with azygous continuation of IVC and the persistent LSVC. Among the right isomerism cases, we had a cardiac TAPVC in 1 patient which showed univentricular heart, the double outlet right ventricle with pulmonary stenosis and right-sided Ayurvedic arch as an associated complex congenital cardiac anomaly and right-sided isomerism with supracardiac TAPVC patient showed double outlet right ventricle with pulmonary stenosis, single coronary artery and persistent left superior venakava, one of the patients also showed complete AV canal defect. Coming to our cases, this was a supracardiac TAPVC in which all the pulmonary veins were joined to form a common chamber posterior superior to left atrium which was ascending as a vertical vein and draining into the left brachosophilic vein which in turn was draining into SVC and right atrium. In this patient we had a osteom secondum as a shunt. Coming to the cardiac type of TAPVC in which all the pulmonary veins were joining to form a common trunk, this common trunk was draining to the right atrium via coronary sinus and this coronary sinus also showed deroofing into the left atrium. There was also a small osteom secondum ASD in this patient. Coming to the infracardiac TAPVC in which this case showed all the four pulmonary veins joining to form a descending vertical vein forming the fertility pattern which was draining to the confluence of portal vein and the splinic vein and this patient also had a osteom secondum ASD as a shunt. Coming to the mixed TAPVC in which cardiac and supracardiac type was seen in our case where left superior lower and lingular segmental pulmonary veins were draining into the left in nominate vein. Left lower and the right-sided pulmonary veins were forming a common chamber. This common chamber was draining into the right atrium via coronary sinus and once again osteom secondum was seen as a shunt in this patient. Coming to the sinus venous defect, this is a defect in the posterior superior wall of the left atrium which separates the right atrium and SVC junction from the left atrium. In this defect the right upper low pulmonary veins will be unroofed into the SVC and this SVC overrides the sinus venous defect and it will be committed to the both atria. Coming to the mild position of septum primum. In this case we had a leftward deviation of the posterior inter atrial septum leading to the drainage of the right-sided pulmonary veins into the right atrium and the left-sided veins into the left atrium. This was a case of coronary atrium in which all pulmonary veins were joining to form a common atrium, a common chamber behind the left atrium. This common chamber was draining into the distal chamber through a non-restrictive opening, suggestive of Loeffler's type III quadratrium and this patient also had DTGA in which iota was seen anterior and to the right of pulmonary atria and also perimembranous outlet VSD seen in this patient. Coming to the congenital venolobar syndrome or type G pulmonary malinascolation. In pulmonary malinascolation we can have either pulmonary atria, vein or lung anomalies. Type G will have all three components which was seen in our case in which inferior pulmonary vein was draining into the suprahepatic IVC. There was a right lung hypoplasia and the hypoplastic pulmonary atria. This patient also had osteum secondum ASD as the shunt. Coming to the right isomerism. This was a case in which liver was centrally located and the bilateral bronchus showed right side morphology with trilobal lungs and common atrium with a complete AV canal defect. Persistent left superior vena keva double outlet right ventricle with the pulmonary stenosis having the bilateral sabatial conus and the single coronary artery arising from the posterior facing sinus. This patient had supracardia TAPVC. This is the common chamber ascending and draining into the superior vena keva. Coming to the left isomerism. You're also liver was centrally located with multiple lobulated spleens. This is the poly spleenia and the bronchus showing the bilateral left sided morphology with the bilobal lungs. And here right-sided veins were draining into the right atrium and the left pulmonary veins were draining into the left atrium. This patient also had a persistent left superior vena keva and IVC interruption with as I guess continuation of IVC. Coming to the conclusion TAPVC was the most common anomalous pulmonary venous drainage followed by sinus venous defect. Malposition of septum premium was the least common pattern. Supracardiac was the most common and the infracardiac was the least common type of TAPVC. Infracardic TAPVC was the most common cause of obstructed TAPVC. ASD was the most common shunt in association with anomalous pulmonary venous return. Among the associated cardiovascular anomalies, persistent LSVC was the most common followed by pulmonary stenosis and DORV. Anomalous pulmonary venous return when associated with the edrotaxa syndrome show, either other complex congenital cardiac anomalies. Cardiac CT is an excellent modality for complete evaluation of anomalous pulmonary venous return and associated cardiac anomalies. This is my reference.