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Logo of thijTexas Heart Institute JournalSee also Cardiovascular Diseases Journal in PMCSubscribeSubmissionsTHI Journal Website
 
Tex Heart Inst J. 2010; 37(4): 494–495.
PMCID: PMC2929861

Functional Pulmonary Atresia in a Critically Ill Premature Infant

Raymond F. Stainback, MD, Section Editor
Department of Adult Cardiology, Texas Heart Institute at St. Luke's Episcopal Hospital, 6624 Fannin St., Suite 2480, Houston, TX 77030

A premature male infant was born at the gestational age of 31 weeks (birth weight, 1,478 g). Resuscitation with chest compressions was performed after birth due to profound bradycardia. Congenital heart disease was suspected because of persistent cyanosis and a grade 3/6 systolic murmur at the left sternal border. Echocardiography was performed immediately, with use of a Philips HP SONOS 5500® imaging system with 12-MHz transducer (Koninklijke Philips Electronics N.V.; Eindhoven, The Netherlands). The right ventricle (RV) and RV outflow tract were structurally intact. However, the pulmonary valve leaflets did not open during systole. No antegrade flow could be seen on the Doppler color-flow map (Fig. 1). Severe tricuspid regurgitation and a large patent ductus arteriosus with left-to-right shunt were noted. The atrial septum bulged from the right atrium into the left atrium. Initially, critical pulmonary stenosis was suspected, because of the presence of pulmonary regurgitation. After the administration of mechanical ventilation and prostaglandin E1 for 1 day, repeat echocardiography showed good pulmonary valve leaflet motion and good antegrade flow (Fig. 2).

figure 24FF1
Fig. 1 On the day of birth, A) the pulmonary valve leaflets do not open during systole, and no antegrade flow is seen on the Doppler color-flow map. B) Continuous-wave Doppler tracing of the pulmonary valve reveals no antegrade flow.
figure 24FF2
Fig. 2 On the 2nd day of life, A) good antegrade flow is seen on the Doppler color-flow map, and B) continuous-wave Doppler tracing of the pulmonary valve reveals normal antegrade flow.

Comment

Functional pulmonary atresia can be seen in certain congenital heart diseases, such as Ebstein anomaly of the tricuspid valve, tricuspid valve dysplasia, Uhl anomaly, and RV hypoplasia.1 However, functional pulmonary atresia is only rarely reported in newborn infants who have anatomically normal hearts.2–6 In our patient, the condition was caused by concomitant severe pulmonary hypertension, RV dysfunction, and tricuspid regurgitation. Performing follow-up echocardiography after providing good general care can avoid unnecessary cardiac catheterization.7 The presence of pulmonary regurgitation is an important diagnostic clue.

Supplementary Material

Video for Fig. 1:
Video for Fig. 2:

Footnotes

Address for reprints: Yun-Ching Fu, MD, PhD, Department of Pediatrics, Taichung Veterans General Hospital, 160, Sec. 3, Chung-Kang Rd., Taichung 407, Taiwan, ROC

E-mail: wt.vog.cthgv@ufnavi

References

1. Freedon RM, Culham G, Moes F, Olley PM, Rowe RD. Differentiation of functional and structural pulmonary atresia: role of aortography. Am J Cardiol 1978;41(5):914–20. [PubMed]
2. Weinhaus L, Jureidini S, Nouri S, Connors RH. Functional pulmonary atresia: color flow recognition and treatment with extracorporeal membrane oxygenation. Am Heart J 1990;119 (4):980–2. [PubMed]
3. Gewillig M, Dumoulin M, Van der Hauwaert LG. Transient neonatal tricuspid regurgitation: a Doppler echocardiographic study of three cases. Br Heart J 1988;60(5):446–51. [PMC free article] [PubMed]
4. Silberbach GM, Ferrara B, Berry JM, Einzig S, Bass JL. Diagnosis of functional pulmonary atresia using hyperventilation and Doppler ultrasound. Am J Cardiol 1987;59(6):709–11. [PubMed]
5. Smallhorn JF, Izukawa T, Benson L, Freedom RM. Noninvasive recognition of functional pulmonary atresia by echocardiography. Am J Cardiol 1984;54(7):925–6. [PubMed]
6. Almeida-Filho OC, Schmidt A, Marin-Neto JA, Maciel BC. Functional pulmonary atresia in a newborn with normal intracardiac anatomy. Pediatr Cardiol 2002;23(6):647–9. [PubMed]
7. Moran AM, Crowley D, Pinette MG, Wax JR. Reversible right ventricular dysfunction and functional pulmonary atresia in the human fetus. J Ultrasound Med 2008;27(3):487–91. [PubMed]

Articles from Texas Heart Institute Journal are provided here courtesy of Texas Heart Institute