Figure 1 X-ray chest Postero-anterior (PA) view at 2 months of
age reported as right upper zone pneumonia.
The child was administered low-flow oxygen and empiric antibiotic
therapy. The septic screen and blood culture results were negative. A
faint murmur was appreciated at the left parasternal region with a loud
S2. 2D echocardiography revealed a large perimembranous
VSD with moderate PDA and severe pulmonary arterialhy pertension (PAH).
Furosemide and spironolactone administration was initiated, and it was
determined that definitive repair could be planned after the infant
exhibited sufficient weight gain. The child was weaned off oxygen and
discharged after 7 days.
On regular subsequent follow-ups, however, the child persisted to
experience cough and tachypnea, as well as growth failure. Hence,
definitive cardiac surgery was performed at the age of 3 months and 7
days.The infant underwent glutaraldehyde-treated pericardial patch
closure of the ventricular septal defect along with patent ductus
arteriosus ligation. The surgical procedure was uneventful.
The child continued to exhibit cough, tachypnea, occasional retraction,
and growth failure after undergoing definitive cardiac surgery. Repeated
evaluations ruled out the presence of infection or congestive cardiac
failure. Serial echocardiography confirmed the success of the cardiac
repair. The child was subsequently lost to follow-up for almost 3
months.
The follow-up was resumed at around 7 months and 15 days of age, with
the persistence of the above complaints. The infant was admitted several
times to a different healthcare facility. He continued to grow poorly,
with a weight of 5.1 kgs. and a length of 62 cms. On repeat X-ray chest
evaluations, hyperlucency of the right middle lobe and crowding of both
the right upper and lower lobes were noted. (Figure 2)