2. Case presentation
• 24 days neonate, product of consangious marriage presented with
chief complaint of;
Cyanosis since birth 3rd day of life
Difficulty in breathing since 3rd day of life
• Term delivery at periphery hospital via SVD. Normal antenatal scans
• At 5th day of life was admitted in hospital where
echocardiography was done, which showed small ASD with L to
R shunt, severe PPHN, mildly dilated RV, EF 64%.
3. HOPC
• History of one sibling death at 2nd month of life due to pneumonia
• All anthropometric measurement between 25th -50th percentile.
• All vitals were normal except for SpO2 80%.
• Central and peripheral cyanosis present.
• S1+S2( P2 loud), no murmur audible. Rest of exam unremarkable.
4. Hospital course
• Repeat Echocardiography showed: Supracardiac TAPVR with vertical
vein obstruction. Moderate size ASD secundum.Dilated right atrium
and ventricle. Severe tricuspid regurgitation 97 mmHg. LVEF 67%.
• Other laboratory investigation were in normal limits.
• Baby admitted in NICU for vertical vein stenting.
11. Post procedure
• Baby shifted to NICU for further management
• OG feed started after 2 hours of procedure
• Next day echocardiography done.
• It showed: Supracardiac TAPVR with vertical vein stents, Moderate
size ASD secundum, Dilate RA and RV, mild TR 30 mmHg, LVEF 70%
and normal RV function.
