A term male infant is found to be cyanotic - denwalk

[ArchivalUser]

to drkhmer
here the option E stands for TAPVR[total anomalous pulmonary venous return]where all of pulmonary veins drain into systemic venous circulation .

answer shud be DD-TRICUSPID ATRESIA.
if am wrong correct me

[ArchivalUser]

_ thank Kola. i may wrong to pick D.
yes, ans E. it could be TAPVR also. TAPVR is pul.vein drain into the right ventricle, but it doesn't drain into systemic vein. correct me, if you have different idea.

[ArchivalUser]

hi drkhmer
kaplan says all the pulmonary veins drain back in to the systemic venous circulation thru a circutous route.mixed blood reaches the left atrium thru an ASD/FO.

but my answer would still be ddddd-tricuspid atresia

[ArchivalUser]

ddddd-tricuspid atresia
cyanosis at birth ,holosystolic murmur,normal sized heart,pulmonary blood flow is determined by a VSD/PDA.,single s2

[ArchivalUser]

hi Kola, if Tricuspid atresia is the ans. how can you explain about CXR ( increase pul.vascular marking) in this pt.?. in Tricuspid atresia, it will decrease pul.blood flow.
_ pls, correct me.

[ArchivalUser]

yes exactly i thought the same and i find only that finding[INCREASED pulmonary vas markings ]against to TA.
LETS WAIT ANd SEE whts the answer.

[ArchivalUser]

_ im thinking about large Truncus arteriosus > Tricuspid atresia.

[ArchivalUser]

E. Classic condition of total anomalous pulmonary venous return (TAPVR). It is characterized by the pulmonary veins forming a confluence behind the left atrium, and draining into the right atrium. Complete mixing takes place in the right atrium, with a right-to-left shunt through the foramen ovale to the left side of the heart. Often, no murmur is heard on cardiac examination, although a short systolic murmur is sometimes heard. ECG often reveals right atrial enlargement and right ventricular hypertrophy. The chest roentgenogram often shows a normal heart size with pulmonary edema. If there is obstruction to pulmonary venous return, as is almost always present with veins draining inferior to the diaphragm, cyanosis can be very prominent. Definitive treatment is surgical anastomosis of the pulmonary vein to the left atrium. Atrial septal defect (ASD) (choice A) is a hole in the septum between the right and the left atria. It results in a left-to-right shunt and causes right ventricular volume overload and increased pulmonary blood flow with a wide S2 split. Approximately 3% to 5% of children with congenital heart disease have an ASD, making it the third most common congenital heart defect. Hypoplastic left heart syndrome (choice B) is characterized by underdevelopment of the left ventricle and the ascending aorta; most patients with hypoplastic left heart syndrome also demonstrate coarctation of the aorta. Typically, there is obstruction at the mitral valve, causing all pulmonary venous blood to shunt through either an ASD or a patent ductus arteriosus (PDA) into the right atrium. Total systemic blood flow is channelled through the ductus arteriosus from the pulmonary artery. As the ductus closes, these infants present with shock because systemic blood flow is significantly reduced. This is classic PDA (choice C) which causes symptoms of pulmonary congestion, dyspnea, widened pulse pressure, and bounding arterial pulsation because aortic blood flow is shunted from left to right. This patency is promoted by continual production of prostaglandin E2 (PGE2) by the ductus. This is Tetralogy of Fallot (choice D) which consists of four cardinal cardiac defects: (1) pulmonary stenosis (PS), (2) a large ventricular septal defect (VSD), (3) right ventricular hypertrophy, and (4) aorta overriding the VSD. The PS causes a harsh systolic murmur easily audible over the upper left sternal border. There is a significant right-to-left shunt because the large VSD allows unrestricted flow from the right ventricle to the left ventricle, causing cyanosis.

http://www.mudpiles.com/reference.html

[ArchivalUser]

E. Classic condition of total anomalous pulmonary venous return (TAPVR). It is characterized by the pulmonary veins forming a confluence behind the left atrium, and draining into the right atrium. Complete mixing takes place in the right atrium, with a right-to-left shunt through the foramen ovale to the left side of the heart. Often, no murmur is heard on cardiac examination, although a short systolic murmur is sometimes heard. ECG often reveals right atrial enlargement and right ventricular hypertrophy. The chest roentgenogram often shows a normal heart size with pulmonary edema. If there is obstruction to pulmonary venous return, as is almost always present with veins draining inferior to the diaphragm, cyanosis can be very prominent. Definitive treatment is surgical anastomosis of the pulmonary vein to the left atrium. Atrial septal defect (ASD) (choice A) is a hole in the septum between the right and the left atria. It results in a left-to-right shunt and causes right ventricular volume overload and increased pulmonary blood flow with a wide S2 split. Approximately 3% to 5% of children with congenital heart disease have an ASD, making it the third most common congenital heart defect. Hypoplastic left heart syndrome (choice B) is characterized by underdevelopment of the left ventricle and the ascending aorta; most patients with hypoplastic left heart syndrome also demonstrate coarctation of the aorta. Typically, there is obstruction at the mitral valve, causing all pulmonary venous blood to shunt through either an ASD or a patent ductus arteriosus (PDA) into the right atrium. Total systemic blood flow is channelled through the ductus arteriosus from the pulmonary artery. As the ductus closes, these infants present with shock because systemic blood flow is significantly reduced. This is classic PDA (choice C) which causes symptoms of pulmonary congestion, dyspnea, widened pulse pressure, and bounding arterial pulsation because aortic blood flow is shunted from left to right. This patency is promoted by continual production of prostaglandin E2 (PGE2) by the ductus. This is Tetralogy of Fallot (choice D) which consists of four cardinal cardiac defects: (1) pulmonary stenosis (PS), (2) a large ventricular septal defect (VSD), (3) right ventricular hypertrophy, and (4) aorta overriding the VSD. The PS causes a harsh systolic murmur easily audible over the upper left sternal border. There is a significant right-to-left shunt because the large VSD allows unrestricted flow from the right ventricle to the left ventricle, causing cyanosis.

http://www.mudpiles.com/reference.html

[ArchivalUser]

http://www.cincinnatichildrens.org/healt.../tapvr.htm

check this, see graphic glossary