- Email: [email protected]
Perinatal asphyxia and cardiac abnormalities
International Journal of Cardiology 147 (2011) e39 – e40 www.elsevier.com/locate/ijcard
Letter to the Editor
Perinatal asphyxia and cardiac abnormalities Giuseppe Dattilo a , Viviana Tulino b , Domenico Tulino c , Annalisa Lamari a , Gabriella Falanga a , Filippo Marte d , Salvatore Patanè d,⁎ a
d
Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy b Department of Pediatrics, Neonatal ICU, University Hospital of Messina, Italy c Operative Unit of Cardiology, Hospital “G. Jazzolino”, Vibo Valentia, Italy Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy Received 13 January 2009; accepted 15 January 2009 Available online 12 February 2009
Abstract The most common etiologies of myocardial infarction in the perinatal period are congenital heart disease, coronary artery lesions, thromboembolism and perinatal asphyxia. Cardiac abnormalities in perinatal asphyxia include tricuspid regurgitation and mitral regurgitation associated with transient myocardial ischemia of the newborn. Patent foramen ovale is a frequent remnant of the fetal circulation. Persistent hypoxia sometimes causes pulmonary arterial hypertension with consequent right to left shunt across patent ductus arteriosus and foramen ovale. We describe a case of tricuspid regurgitation, mitral regurgitation, and patent foramen ovale in a 15-day-old newborn male infant with a history of perinatal asphyxia. Also this case focuses attention on the perinatal asphyxia. © 2009 Elsevier Ireland Ltd. All rights reserved. Keywords: Cardiac abnormalities; Mitral regurgitation; Patent foramen ovale; Perinatal asphyxia; Tricuspid regurgitation
1. Case report The most common etiologies of myocardial infarction in the perinatal period are congenital heart disease, coronary artery lesions, thromboembolism and perinatal asphyxia [1,2]. Cardiac abnormalities in perinatal asphyxia include tricuspid regurgitation [3] and mitral regurgitation associated with transient myocardial ischemia of the newborn [4]. Patent foramen ovale is a frequent remnant of the fetal circulation [5]. Persistent hypoxia sometimes causes pulmonary arterial hypertension with consequent right to left shunt across patent ductus arteriosus and foramen ovale [4]. We describe a case of tricuspid regurgitation, mitral regurgitation, and patent foramen ovale in a 15-day-old newborn male infant with a history of perinatal asphyxia. A 15-day-old newborn male infant was referred to the Cardiology Unit for a
⁎ Corresponding author. Tel.: +39 3402783962. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2009.01.032
cardiovascular checkup. A history of perinatal asphyxia was present with a reported Apgar score of 7 at 1st minute and of 8 at 5th minute. Echocardiographic evaluation revealed a mild mitral regurgitation, a mild tricuspid regurgitation (Fig. 1A) and a mild pulmonary regurgitation (Fig. 1B). A patent foramen ovale was also observed (Fig. 2A and B). Also this case focuses attention on the perinatal asphyxia. Acknowledgement The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [6].
References [1] De Lucia V, Andreassi MG, Sabatini L, Ait-Ali L, Spadoni I, Giusti S. Myocardial infarction and arterial thrombosis in identical newborn twins with homozygosity for the PAI-1 4 G/5 G polymorphism. Int J Cardiol 2009;137:e1–4.
e40
G. Dattilo et al. / International Journal of Cardiology 147 (2011) e39–e40
Fig. 1. Panel A, transthoracic echocardiography, apical view, a mild mitral regurgitation and a mild tricuspid regurgitation. Fig. 1 Panel B, transthoracic echocardiography, parasternal view, a mild pulmonary regurgitation.
Fig. 2. Panel A, transthoracic echocardiography, apical view, a patent foramen ovale. Fig. 2 Panel B, transthoracic echocardiography, subcostal view, a patent foramen ovale.
[2] MacDonald HM, Mulligan JC, Allen AC, Taylor PM. Neonatal asphyxia. I. Relationship of obstetric and neonatal complications to neonatal mortality in 38,405 consecutive deliveries. J Pediatr May 1980;96(5):898–902. [3] Pinto CA, Herdy GV, Ferrari AH, et al. Severe tricuspid valve insufficiency due to papillary anterior muscle infarction of the right ventricle secondary to neonatal hypoxia. Arq Bras Cardiol Jun 1992;58(6):475–8.
[4] Ranjit MS. Cardiac abnormalities in birth asphyxia. Indian J Pediatr Mar 2000;67(3 Suppl):S26–9 [Review]. [5] Drighil A, El Mosalami H, Elbadaoui N, Chraibi S, Bennis A. Patent foramen ovale: a new disease? Int J Cardiol Oct 31 2007;122(1):1–9 [Electronic publication 2007 Mar 28. Review]. [6] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131:149–50.
Letter to the Editor
Perinatal asphyxia and cardiac abnormalities Giuseppe Dattilo a , Viviana Tulino b , Domenico Tulino c , Annalisa Lamari a , Gabriella Falanga a , Filippo Marte d , Salvatore Patanè d,⁎ a
d
Clinical and Experimental Department of Medicine and Pharmacology, University of Messina, Messina, Italy b Department of Pediatrics, Neonatal ICU, University Hospital of Messina, Italy c Operative Unit of Cardiology, Hospital “G. Jazzolino”, Vibo Valentia, Italy Cardiologia Nuovo Presidio Ospedaliero Cutroni Zodda-Barcellona P.d.G(Me) AUSL5 Messina, Via Cattafi, 98051 Barcellona Pozzo di Gotto, Messina, Italy Received 13 January 2009; accepted 15 January 2009 Available online 12 February 2009
Abstract The most common etiologies of myocardial infarction in the perinatal period are congenital heart disease, coronary artery lesions, thromboembolism and perinatal asphyxia. Cardiac abnormalities in perinatal asphyxia include tricuspid regurgitation and mitral regurgitation associated with transient myocardial ischemia of the newborn. Patent foramen ovale is a frequent remnant of the fetal circulation. Persistent hypoxia sometimes causes pulmonary arterial hypertension with consequent right to left shunt across patent ductus arteriosus and foramen ovale. We describe a case of tricuspid regurgitation, mitral regurgitation, and patent foramen ovale in a 15-day-old newborn male infant with a history of perinatal asphyxia. Also this case focuses attention on the perinatal asphyxia. © 2009 Elsevier Ireland Ltd. All rights reserved. Keywords: Cardiac abnormalities; Mitral regurgitation; Patent foramen ovale; Perinatal asphyxia; Tricuspid regurgitation
1. Case report The most common etiologies of myocardial infarction in the perinatal period are congenital heart disease, coronary artery lesions, thromboembolism and perinatal asphyxia [1,2]. Cardiac abnormalities in perinatal asphyxia include tricuspid regurgitation [3] and mitral regurgitation associated with transient myocardial ischemia of the newborn [4]. Patent foramen ovale is a frequent remnant of the fetal circulation [5]. Persistent hypoxia sometimes causes pulmonary arterial hypertension with consequent right to left shunt across patent ductus arteriosus and foramen ovale [4]. We describe a case of tricuspid regurgitation, mitral regurgitation, and patent foramen ovale in a 15-day-old newborn male infant with a history of perinatal asphyxia. A 15-day-old newborn male infant was referred to the Cardiology Unit for a
⁎ Corresponding author. Tel.: +39 3402783962. E-mail address: [email protected] (S. Patanè). 0167-5273/$ - see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2009.01.032
cardiovascular checkup. A history of perinatal asphyxia was present with a reported Apgar score of 7 at 1st minute and of 8 at 5th minute. Echocardiographic evaluation revealed a mild mitral regurgitation, a mild tricuspid regurgitation (Fig. 1A) and a mild pulmonary regurgitation (Fig. 1B). A patent foramen ovale was also observed (Fig. 2A and B). Also this case focuses attention on the perinatal asphyxia. Acknowledgement The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [6].
References [1] De Lucia V, Andreassi MG, Sabatini L, Ait-Ali L, Spadoni I, Giusti S. Myocardial infarction and arterial thrombosis in identical newborn twins with homozygosity for the PAI-1 4 G/5 G polymorphism. Int J Cardiol 2009;137:e1–4.
e40
G. Dattilo et al. / International Journal of Cardiology 147 (2011) e39–e40
Fig. 1. Panel A, transthoracic echocardiography, apical view, a mild mitral regurgitation and a mild tricuspid regurgitation. Fig. 1 Panel B, transthoracic echocardiography, parasternal view, a mild pulmonary regurgitation.
Fig. 2. Panel A, transthoracic echocardiography, apical view, a patent foramen ovale. Fig. 2 Panel B, transthoracic echocardiography, subcostal view, a patent foramen ovale.
[2] MacDonald HM, Mulligan JC, Allen AC, Taylor PM. Neonatal asphyxia. I. Relationship of obstetric and neonatal complications to neonatal mortality in 38,405 consecutive deliveries. J Pediatr May 1980;96(5):898–902. [3] Pinto CA, Herdy GV, Ferrari AH, et al. Severe tricuspid valve insufficiency due to papillary anterior muscle infarction of the right ventricle secondary to neonatal hypoxia. Arq Bras Cardiol Jun 1992;58(6):475–8.
[4] Ranjit MS. Cardiac abnormalities in birth asphyxia. Indian J Pediatr Mar 2000;67(3 Suppl):S26–9 [Review]. [5] Drighil A, El Mosalami H, Elbadaoui N, Chraibi S, Bennis A. Patent foramen ovale: a new disease? Int J Cardiol Oct 31 2007;122(1):1–9 [Electronic publication 2007 Mar 28. Review]. [6] Coats AJ. Ethical authorship and publishing. Int J Cardiol 2009;131:149–50.