VSD AND TOF

1.  13 month old male
 h/o by grandfather & mother
 FTNVD . BIRTH Wt 3.5 kg cried immediately after
birth
 At 1 month weight 3 kg .(poor weight gain )
 Vaccinated till date
 1 H/o episodes of LRTI in past 19/3/21 (admitted )
 No h/o joint pains in past
 No h/o cyanosis / suck rest suck cycle
 No h/o chest pain

2.  O/E: PR- 133 /min, regular
 BP- 84/62 mm Hg
 RR- 37/min
 Baby irritable
 Temp 101.4F
 Wt- 7 kg, Ht- 63.5cm
 SpO2 = 96% on room air
 CVS- S1 – present, normal in intensity
 pansystolic murmur , intensity 4/6 best
heard in left third and fourth LICS .
 No S3
 Chest – air entry equal
 P/A –soft non tender

3. 130/min , regular , RAE , RAD (120 ) , tall biphasic complex in v2-v6, tall R
waves (RVH ),strain pattern in lat leads , LVH (V2+V6 > 35mm)

4. Cardiomegaly /
LAE(double
density & oblique
measurement
>7cm LAA
convex (third
mogul sign )/
splaying of
carinal angle
>70
Prominent pulm
vasculature(hila
/dilated pa )
RV apex ,

5.  Situs solitus /levocardia
 Svc and ivc draining to Right atrium
 Perimembranous vsd 1.5 cm bidirectional
shunt
 RV= LV Size
 Diag- ACHD with PM-VSD ( Bidirectional
shunt)

6. OFF
0XYGEN
PRESSURE ON OXYGEN PRESSURE
SVC 42 65
RA 10 10/4/6
RV
PA 80 96/34/70 95 88/39/65
PAWP
PV 98
(ASSUMED )
100(ASSUME
D)
FA 93 100/50/70 100 100/54/74
LVDP 10 20

7.  Wt- 7 Kg
 Ht- 63.5 cm
 BSA- 0.33 m2
 Hb = 11.0 mg/dl
 VO2 absolute = 3.43 *height in cm -7.83 *
weight (kg) +0.38 * HR -54.1 = 157.2 ml/min
Pediatr Cardiol. Jul-Aug 1996;17(4):207-13.Oxygen consumption in infants and children during heart
catheterization
B P Lundell 1, M L Casas, C G Wallgren

13.  3 year ,male child
 History of bluish discolouration of skin and
mucosa during crying and feeding from 6
month of age
 History of failure to thrive.
 No history of recurrent respiratory tract
infections.
 no history of cough ,syncope.

14.  Height -85 cm,weight-13 kg
 Pulse -110/min
 BP-96/74 mm of Hg in Right arm supine posture.
 RR-22/mt
 Temp-afebrile
 Cyanosis and clubbing present.
 CVS -S1-normal
-A2 normal,P2 -soft
-s3 and s4 not heard
-ESM grade 3/6 heard in left 2nd ICS

15. Xray pa view , exp film , adequate exposure , with oligemic lung field,
CTR <50% , RV apex , boot shaped heart , right aortic arch

16. 110/min , regular , marked RAD (145) , clockwise loop (q in iii/avF ) , early
transition of R wave in v2 , tall p in lead ii s/o RAE , tall r in v1 and s in v6
with t inversion s/o-RVH

17.  Situs solitus , levocardia
 3pul vein -> left atrium
 A-v concordance
 No ASD
 Large sub aortic VSD (bifirectional shunt)
 Infundibular + valvular PS (grad 90mm hg)
 No coarctation of aorta /PDA
 Mitral annulus 1.8*1.5 cm
 Diag –TOF with confluent pulmonary arteries
with single subaortic VSD