A Five (5) chamber heart (Cor Triatriatum) in Infancy: A rare congenital heart defect
A female baby seen on the second day of life was delivered by a 25-year-old primiparous Youth Corper. The mother attended antenatal clinic in Federal Medical Centre Owerri from the 16th week of gestation. However, during the 8th week of pregnancy, the mother had threatened abortion for which some drugs were given (injections and tablets names unknown) at a hospital in Lagos. She also had some liquid herbal preparation at 8 months of gestation; other drugs she took were essentially haematinics. She denied a history of alcohol, coffee and cigarette use. The pregnancy was carried to term. She went into spontaneous labour with an 18-h history of rupture of membrane. Delivery was spontaneous, vertex and supervised by medical personnel. She gave birth to a 3.6-kg baby girl who cried immediately after, and breastfeeding commenced. The child was transferred to the Special Care Baby Unit from the postnatal ward on account of history of fever on day 2 of life.\nExamination revealed a full-term newborn, febrile (38.1©) with a respiratory rate of 100 cycles per minute, acyanotic, heart rate of 110 beats/min heart sound- I and II only no murmur heard. A diagnosis of probable neonatal sepsis was made. Investigations carried out included blood culture that did not yield any growth. However, the child completed a course of antibiotics (Ampicillin–Sulbactam and Gentacin) and, with clinical improvement, was discharged home.\nAt follow-up at the 2nd week of life, the child weighed 3.5 kg, heart rate was 130 beat/min and a grade 3 pansystolic murmur was heard, following which a chest radiograph and electrocardiograph (ECG) was requested.\nAt 1 month of life, a review of ECG showed:\nheart rate: 128 beats/min,\nRR: 468 mS,\nP: 70 mS,\nPR: 94 mS,\nQRS: 54 mS,\nQT: 290 mS,\nQTc: 426 mS,\nAxis P-39©,\nQRS-147© and\nT-18, which suggested supraventricular arrhythmia, abnormal right superior axis deviation.\nChest radiograph showed perihilar mottling on both the lung fields. Heart and thoracic cavity were within normal limits. An impression of bronchopneumonia was made by the Consultant Radiologist.\nMurmur was still grade 3/6, pansystolic maximal at the left-lower sternal edge.\nEchocardiograph was subsequently requested and the result showed that a 2D echocardiogram was done [] with the following results:\nSitus solitus\nSeparate left atrium with dividing membranous running in the direction of long axis of left atrium close to the lateral wall.\nNo evidence of flow across the septum. Mitral valve draining the larger, more medial chamber, normal atrio-ventriculo-arterial connection. Normal relationship of aortic root to the pulmonary trunk.\nSupravalvular pulmonary membrane causing stenosis noted. High velocity turbulent flow in the main artery noted (PA Vmax = 335 cm/s PG = 45 mm).\nSecundum atrial septal defect about 1.2 mm noted with left to right shunt.\nNormal wall motion and thickness, good global left ventricular contractility.\nNormal pericadium.\nConclusion\nCor Triatrietum.\nSupravalvular pulmonary stenosis.\nSecundum atrial septal defect []\nThe child is presently being followed-up regularly. During her last visit, at 7 months of age, she weighed 9.6 kg, length was 73 cm, occipito-frontal circumference was 47 cm and mid-upper-arm circumference was 15 cm (all within normal for age).\nCardiovascular examination revealed a child with heart rate of 120 beats/min, apex beat located at the 4th left intercostals space, with a grade 3/6 systolic murmur heard loudest at the upper left sternal edge. The respiratory rate was 42 cycles/min and no organs palpably enlarged on digestive system examination.