This learning activity provides a comprehensive overview of obstructed Total Anomalous Pulmonary Venous Return (TAPVR), a critical congenital heart defect where some or all of the pulmonary veins fail to connect normally to the left atrium, leading to severe hypoxia and congestive heart failure if untreated. It delineates the anatomy, pathophysiology, clinical presentation, and nursing assessment of obstructed TAPVR, emphasizing the importance of prompt intervention and specialized nursing care. The essay covers topics such as respiratory and cardiovascular support, preoperative stabilization, postoperative care, and family support. It also addresses the epidemiology, complications, challenges, and long-term outcomes associated with obstructed TAPVR, highlighting the multidisciplinary approach required for optimal management and improved survival rates.