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Boletín médico del Hospital Infantil de México

versión impresa ISSN 1665-1146

Resumen

BETANCOURT-MONTOYA, Minerva  y  CORONA-VILLALOBOS, Carlos. From an innocent heart murmur to pulmonary arterial hypertension. Bol. Med. Hosp. Infant. Mex. [online]. 2019, vol.76, n.6, pp.287-293.  Epub 13-Mar-2020. ISSN 1665-1146.  https://doi.org/10.24875/bmhim.19000068.

Background:

The detection of congenital heart disease in newborns, based on a heart murmur or cyanosis is not effective. Critical congenital heart diseases, such as truncus arteriosus (TA), cause most of neonatal deaths due to congenital malformations. The screening for pulse oximetry in newborns detects up to 70% of these heart diseases. TA presents high mortality in the first year of life.

Case report:

A 4-year-old female patient with a heart murmur, palpitations, dyspnea, and perioral cyanosis was diagnosed with an innocent heart murmur at birth. TA was detected by echocardiography. Pulmonary vascular resistances were evaluated through right cardiac catheterization, and pulmonary arterial hypertension and pulmonary vasoreactivity were diagnosed as well. Surgical correction was performed. Currently, pulmonary arterial hypertension persists, for which Bosentan® (Actelion, USA) has been implemented as a long-term treatment.

Conclusions:

In newborns, the pulse oximetry screening after 24 hours of life is an effective method for suitable diagnosis of critical congenital heart disease before the signs of cardiovascular collapse. Therefore, it has become an essential diagnostic tool to reduce morbidity and mortality. Although the surgical correction of congenital heart disease with pulmonary arterial hypertension is feasible in some patients, its subsequent management is complex and has an adverse impact on the quality of life.

Palabras llave : Heart murmurs; Congenital heart defect; Truncus arteriosus; Screening; Pulse oximetry; Pulmonary arterial hypertension.

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