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)