Clinical History A 5-year-old girl was born in mainland China and diagnosed to have congenital heart disease in early infancy. No intervention was offered. She came to HK 3 months ago and presented to the general practitioner with cyanosis and heart murmur. She was noticed to be “blue” since early infancy. She has satisfactory exercise tolerance but her mother noticed that she became more “blue” after running. This is the second child of the family, born full term by spontaneous vaginal delivery with a birth weight of 3.5 kg. The antenatal and perinatal history was uneventful. Her father is a driver and mother is a housewife. Her 15-year-old elder brother is healthy. The general practitioner found that she was cyanotic and heard a loud heart murmur. She was then referred for cardiac assessment.
Q1 - What is the abnormality? Close
Try to answer:
Answer - Clubbing of fingers close
Q2 - What is the abnormality? Close
Answer - Boot-shaped heart close
Q3 - What are the abnormalities? Close
Answer - Right axis deviation, Right ventricular hypertrophy close
Q4 - Is the congenital heart disease likely to be "duct-dependent" or "duct-independent" ? Close
Duct-dependent Duct-independent
Answer - Duct-independent close
Q5 - What is/are the most likely congenital heart lesion(s)? Close
Atrial septal defect Patent ductus arteriosus Tetralogy of Fallot Aortic stenosis Coarctation of aorta
Answer - Tetralogy of Fallot close
Q6 - What are the key features in tetralogy of Fallot? Close
Answer - ventricular septal defect, right ventricular outflow tract obstruction/pulmonary stenosis, overriding aorta, right ventricular hypertrophy close
Dr. Eddie WY Cheung & Dr YF Cheung Department of Paediatrics & Adolescent Medicine The University of Hong Kong