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• W3000341853 abstract "Abstract Funding Acknowledgements Not applicable OnBehalf Not applicable A 25 days old neonate, weighing 2.8kg was brought with complaints of feeding difficulties, not gaining birth weight and rapid breathing. The parents had not noticed any cyanosis. He was further referred to us as the treating paediatrician heard a pansystolic murmur over the left sternal border. When examined, baby was afebrile, tachypnoea (70 per minute), regularly tachycardia(180bpm). We did not appreciate any dysmorphism. On cardiovascular examination we found a mild cardiomegaly, RV S3, mild hepatomegaly with no signs of active infection. Systemic saturations were 98% in all limbs. Other systemic examinations were essentially normal. 12 lead ECG showed, physiological RV dominance, with no signs of LV volume overload. Chest radiograph showed cardiomegaly of RV type with adequate PBF. 2 D echocardiogram : The intra-cardiac structures were found to be normal. A huge coronary-cameral fistula originating from RCA, traversing in right AV groove and draining into the RV with mild RV enlargement. No signs of PAH. Biventricular function was preserved. CT coronary angiogram : CT confirmed the presence and anatomy of the RCA—RV fistulous tract seen on echocardiography. The fistula measured ∼ 6mm at the origin and 3.5mm at the point of entry into RV. As we could not see any PDA arising from RCA and a twig from LCX traversing in interventricular groove, we thought it’s a left dominant coronary circulation. Hemodynamics in the index case The symptoms of heart failure in the index neonate is due to the volume overload on the RV. The non-dominance of RCA is probably a blessing in disguise for this baby in preventing coronary steal. The steal phenomenon will be apparent once the physiological (high) PVR comes down. Plan Baby is on diuretics and nutritional support, under weekly follow up. We will be performing catheter study (around 12 weeks of life or as per clinical indications) to look for dominance and need/feasibility of device closure. Abstract P876 Figure." @default.
• W3000341853 created "2020-01-23" @default.
• W3000341853 creator A5033501921 @default.
• W3000341853 date "2020-01-01" @default.
• W3000341853 modified "2023-09-27" @default.
• W3000341853 title "P876 I may still steal you : huge coronary cameral fistula (non-dominant right coronary artery to right ventricle) in a neonate causing heart failure" @default.
• W3000341853 doi "https://doi.org/10.1093/ehjci/jez319.519" @default.
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