WY Leung, JKJ Ip, BHY Chung

A baby girl born via lower section caesarian section to a healthy Chinese couple at 38 weeks of gestational age presented with right heart failure and poor feeding on day 2 of life, and was transferred to our hospital. Apgar scores were 9 at 1 minute and 10 at 5 and her birth weight was 3.16 kg. Antenatal history was unremarkable. The girl is the second child in the family and the family history was unremarkable.

There was mild desaturation since birth. On physical examination, body temperature was 36.5°C, heart rate was 140 beats per minute, respiratory rate was 60 breaths per minute and mean arterial blood pressure was 50 mmHg. Skin mottling, a loud P2 heart sound, a grade 3/6 pansystolic murmur over the left lower sternal border, a systolic cranial bruit and hepatomegaly were reported. Figure 1 shows the chest X-ray on admission. Echocardiogram revealed dilated right atrium and ventricle, dilated inferior vena cava, moderate to severe tricuspid regurgitation, patent ductus arteriosus and patent foramen ovale with pulmonary hypertension. Magnetic resonance imaging (MRI), with magnetic resonance arteriogram (MRA) and magnetic resonance venogram (MRV), were subsequently performed (Figures 2a-e).

Figure 1 Chest X-ray.

Figure 2 (a) T1-weighted MRI in axial plane. (b) T2-weighted MRI in axial plane. (c) Post-contrast T1-weighted MRI in axial plane. (d) Time of flight (TOF) MRA in axial plane. (e) Post-contrast MRV in axial plane.

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