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CASE REPORT


PERSONNAL DETAILS
• Patient name : NGUYEN THI TO UYEN
• Gender

: Female

• Birthdate

: April 14, 1999

• Address

: Dac Lac province

• Date of consultation
• Chief complaint

: Feb 14, 2003

: Dyspnea


HISTORY
• The congenital heart disease had been detected at 10 months
old after an episode of acute bronchitis.

• Recurrent respiratory infections.

• Exertional dyspnea, diaphoresis, failure to thrive .

• No cyanosis


PAST HISTORY
• Birth weight : 3kg ; 2nd daughter, the elder is normal

• Mother : normal gestation


PHYSICAL EXAMINATION
• 1st examination (April 8, 2002 - 3 years old)
W : 8.5 kg

H : 82 cm

HR : 130bpm

• Cardiac apex : 5th LICS, on MCL
Systolic murmur grade 4/6 at 2nd LICS

Systolic click (+).
No pulmonary rales

Liver : 2 cm below costal margin
No other abnormalities


PHYSICAL EXAMINATION

• 2nd examination (Feb 14, 2003 – 4 y.o)
Hypotrophic W : 9kg
H : 82cm
HR : 136 bpm
RR : 36/mn
Paroxysmal nocturnal dyspnea, orthopnea
Precordial bulge
Cardiac apex : 6th LICS, 1 cm out of MCL
Systolic murmur grade 2/6 at 2nd LICS ; Diastolic murmur
of pulmonary regurgitation (+)
P2 accentuated
Liver : 4 cm below costal margin
No other abnormalities


ECG (1)
(April 8, 2002)

Sinus rhythm; regular rate 120 bpm

QRS axis North-Westh region
Right atrial and ventricular enlargement

Incomplete RBBB



ECG (2)
(Feb 14, 2003)
Sinus rhythm; regular rate 136bpm

Right QRS axis
Right atrial and ventricular enlargement
Incomplete RBBB
First-degree atrioventricular block



Chest radiograph (1)
(April 8, 2002)
Chest/thorax ratio 0.73;

Right atrial and ventricular enlargement, left atrial and

ventricular enlargement .

Main pulmonary artery is prominent, increased pulmonary
vascular markings.



Chest radiograph (2)
(Feb 14, 2003)

• Cardiomegaly.
• Main pulmonary artery is
prominent.
• Increased pulmonary
vascular markings.

TTE
(Feb 14, 2003) (H: 82cm; W: 9 kg; BSA: 0.42m2)
▪ Levocardia with situs solitus .
▪ Common atrium.
▪ Both atrioventricular valves are inserted downward at the
same level. Two AV valves annuli.
▪ The cleft of the anterior leaflet of the mitral valve results

in mitral regurgitation (4/4). Two papillary muscles of the
left ventricle are lateralized


▪ Tricuspid regurgitation (4/4). Systolic pulmonary artery

pressure: 100mmHg
▪ Pulmonary insufficiency (++). Mean pulmonary artery

pressure: 50mmHg
▪ Left and right ventricular enlargements. The septal motion

is paradoxical.

DIAGNOSIS
▪

Partial atrioventricular septal defect

▪

Severe mitral and tricuspid regurgitation

▪

Pulmonary hypertension

▪

Severe congestive heart failure