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Vol. 3. Núm. 4 - 5.
(Julio - Octubre 2020)
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Vol. 3. Núm. 4 - 5.
(Julio - Octubre 2020)
Images in medicine
DOI: 10.1016/j.mcpsp.2020.100117
Open Access
Congenital heart disease at 21 years old
Enfermedad cardíaca congénita a los 21 años
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Ana Rita Alves Lopes
Autor para correspondencia
rit.lopes@hotmail.com

Corresponding author.
, Rita Silva, Rui Terras
Servicio de Medicina Interna, de la Unidade Local de Saúde do Nordeste – Unidade Hospitalar de Bragança, Portugal
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A 24-year-old man with occasional consumption of alcohol and tobacco, without other significant medical history presented to the Emergency department reporting dyspnea on exertion for 2weeks. He had history of headache, dizziness and fatigability with lack of concentration on daily activities for 4 years. Unemployed due to illness.

On examination blood pressure 128/71mmHg, heart rate 87bpm, oxygen saturation of 81% without supplemental oxygen, marked central cyanosis and clubbing present, edema absent, JVP not raised, chest wall deformity with a scoliosis, a normal cardiopulmonary auscultation.

A room air arterial blood gases revealed significant hypoxemic respiratory failure (pO2 45%). On investigation, hemoglobin was 18.9g/dL and haematocrit 53.8%. ECG showed features of ventricular hypertrophy. Chest radiograph showed cardiomegaly. Echocardiography showed congenital cardiac disease with: a complete atrioventricular septal defect (with free communication between 4chambers) (Fig. 1) with a single atrioventricular valve (Fig. 2), reduced vertex inter-ventricular communication, wide communication inter-atrial (30mm); severe pulmonary hypertension (PSAP 80mmHg), preserved ejection fraction, cavities within the limits of normality1-4.

Fig. 1.

Echocardiography: complete atrioventricular septal defect, reduced vertex inter-ventricular communication, wide communication inter-atrial (arrow).

(0,08MB).
Fig. 2.

Echocardiography: a single atrioventricular valve (arrow).

(0,07MB).

Cerebral computed tomography (CT) was normal and chest CT revealed a marked increase in the caliber of the pulmonary artery (43mm) and presence of a bilateral mosaic pattern, excluding pulmonary thromboembolism. The patient was diagnosed with Eisenmenger Syndrome secondary to untreated congenital cardiac defect.

References
[1]
C.H. Costa, R. Rufino.
Hipertensão Arterial Pulmonar associada às cardiopatias congênitas.
Pulmão RJ, 24 (2015), pp. 43-46
[2]
J. Calderón-Colmenero, J.S. Zárate, M.B. Gámez.
Hipertensión pulmonar asociada a cardiopatías congénitas y síndrome de Eisenmenger.
Arch Cardiol Mex, 85 (2015), pp. 32-49
[3]
F. Azevedo Simão, F.M. Pena, F.A. Carvalho, C.A. Cardozo de Faria.
Síndrome de Eisenmenger e comunicação interatrial.
Insuf Card, 5 (2010), pp. 197-200
[4]
Álvaro Albrecht. Eisenmenger: doença e história. Revista da Sociedade de Cardiologia do Rio Grande do Sul- Ano XIII no 01 Jan/FevMar/Abr 2004
Copyright © 2020. The Authors
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