Neonatal Asphyxia and Functional Tricuspid Atresia

Abstract

The patient was a 2,700 gm full term female, the product of a normal 41-week pregnancy and delivery. She was noted to have cyanosis and labored breathing at birth. The Apgar scores were 5 and 6 at 1 and 5 minutes respectively. The heart sounds were heard best on the right side of the chest. No murmur was present. The breath sounds were poor and bowel sounds were audible in the left chest. The abdomen was scaphoid and the liver was not palpable. There was hypoplasia of the left arm and hand with a contracture of the left axilla. Chest roentgenogram revealed the presence of the liver and bowel loops in the left chest. The baby was intubated and placed on a respirator in 100 percent O2. The pH was 6.6, PO2 was 20, and the PCO2 was 85 mm Hg. The baby was treated with trishydroxyam-inomethane (THAM). At operation, a left-sided foramen of Bochdalek hernia and hypoplasia of the left lung were found. The hernia was reduced and the diaphragmic defect repaired. The patient remained severely hypoxic and acidotic despite maximal ventilatory pressures, 100 percent oxygen, and therapy with THAM. In an attempt to decrease the pulmonary vascular resistance, the patient was brought to the cardiac catheterization laboratory for infusion of tolazoline into the pulmonary artery. A French No. 4 Berman angiographic catheter was advanced to the right atrium, left atrium, and left ventricle, but could not be inserted into the right ventricle despite numerous attempts. AP angiography was therefore performed with injection into the right atrium (Fig 1). The infant expired two hours after catheterization.