Article Data

  • Views 1383
  • Dowloads 141

Case Report

Open Access

Overt yet unrecognized cyanosis in a 3-year old boy with right pulmonary artery-to-left atrium communication: malpractice or ignorance?

  • NEVEN ČAČE1
  • ALEKSANDAR OVUKA2
  • IVA BILIĆ ČAČE2
  • SR􀀃AN BANAC 2
  • VOJKO ROŽMANIĆ2
  • VLADIMIR AHEL2

1,Department of Pediatrics University Hospital of Rijeka

2,University Hospital of Rijeka

DOI: 10.22514/SV72.102012.9 Vol.7,Issue 2,October 2012 pp.50-52

Published: 29 October 2012

*Corresponding Author(s): NEVEN ČAČE E-mail: ncace1@gmail.com

Abstract

We present the case of a 3 year-old boy with obvious and severe blue discoloration of the skin and mucous membranes, pre-sent since birth, accompanied by clubbing of the fingers. He lives in the city and has been seen regularly by his pediatrician, and yet was never recognized as cyanotic. Cardiac examination revealed a soft systolic heart murmur. Electrocardiography (ECG) and blood pressure were normal and all peripheral pulses were present. Laboratory tests showed arterial hypoxia and polycythaemia. Echocardiography (ECHO), Doppler, angiography and multi-slice computed tomography pulmonary angiogram were performed. A right pulmonary artery-to-left atrium communication was diagnosed. Other possible causes of cyanosis were excluded. The child underwent surgery. At follow-up, one year later, the child was in excellent health. Labo-ratory tests were within referent values and oxygen saturation was normal. Repeated ECHO studies showed a progressive decrease in the size of the left atrium. This case illustrates the importance of careful physical examination during everyday practice and emphasizes the importance of collaboration between the physician and parents to ensure child wellbeing.

Keywords

cyanosis, clubbing, right- to- left shunt

Cite and Share

NEVEN ČAČE,ALEKSANDAR OVUKA,IVA BILIĆ ČAČE,SR􀀃AN BANAC ,VOJKO ROŽMANIĆ,VLADIMIR AHEL. Overt yet unrecognized cyanosis in a 3-year old boy with right pulmonary artery-to-left atrium communication: malpractice or ignorance?. Signa Vitae. 2012. 7(2);50-52.

References

1. Friedlich A, Bing RJ, Blount Jr SG. Physiological studies in congenital heart disease IX. Circulatory dynamics in the anomalies of venous return to the heart including pulmonary arteriovenous fistula. Bull Johns Hopkins Hosp 1950;86:20-57.

2. Zeebregts CJ, Nijveld A, Lam J, van Oort AM, Lacquet LK. Surgical treatment of a fistula between the right pulmonary artery and the left atrium: presentation of two cases and review of literature. Eur J Cardiothorac Surg 1997;11:1056-61.

3. Alexi Meskishvili V, Dahnert I, Ovroutski S, Hetzer R. Right pulmonary artery-to-left atrium communication. Tex Heart Inst J 2001;28:120-4.

4. Saatvedt K, Stake G, Lindberg H. Fistula between the right pulmonary artery and left atrium—an unusual cause of cyanotic heart disease. Cardiol Young 1995;5:85-7.

5. Margaryan R, Arcieri L, Cantinotti M, Murzi B. Surgical closure of big pulmonary artery-left atrial fistula Interact. CardioVasc Thorac Surg 2010;10:113-4.

6. Slack MC, Jedeiken R, Jones JS. Transcatheter coil closure of a right pulmonary artery-to-left atrial fistula in an ill neonate. Cath Cardiovasc Interven 2000;50:330-3.

7. Allen HD, Phillips RP, Chan PD. History and Physical Examination. In: Hugh DA, Howard PG, Edward BC, David JD, editors. Moss and Adams Heart disease in infants, children and adolescents. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2001.

8. Perloff JK. The clinical recognition of congenital heart disease. 5th ed. Philadelphia: Saunders; 2003.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time

Conferences

Top