Abstract
A group of 19 cyanotic term neonates, whose minimal evidence of pulmonary pathology led to an initial diagnosis of cyanotic congenital heart disease, was studied to delineate the nature of the right to left shunt. The mothers' pregnancies were complicated in 90%. Initial Apgar scores were often high (80%>7), Electrocardiograms were normal or showed right ventricular hypertrophy.
Five infants (10-39 hours) had cardiac catheterization; none had anatomic heart disease. All had high pulmonary vascular resistance, equalling or exceeding systemic resistance. Pulmonary venous oxygen saturations ranged from 92-100%; simultaneous aortic saturations were 57-83%. Angiography showed massive right to left shunting at the ductus arterlosus In all cases.
The mechanism of the postnatal persistence of fetal right to left flow through the ductus arteriosus is unclear. The associated maternal and placental problems may contribute to chronic fetal hypoxia. Goldberg (Pediat.48:528,1971) described an increase In the muscularity of the fetal pulmonary vascular bed after intrauterine hypoxia. This may contribute to these Infants' abnormal pulmonary vasoconstriction.
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Drummond, W., Rashkind, W. & Peckham, G. PERSISTENT PULMONARY HYPERTENSION IN CYANOTIC TERM NEONATES WITHOUT ANATOMIC HEART DISEASE. Pediatr Res 8, 348 (1974). https://doi.org/10.1203/00006450-197404000-00050
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DOI: https://doi.org/10.1203/00006450-197404000-00050