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Mailing Address: Edmar Atik • InCor – Av. Dr. Enéas C. Aguiar, 44 05403-000 – São Paulo, SP, Brazil E-mail: conatik@incor.usp.br Clinical findings Thirteen-year-old white male teenager presented with cyanosis since birth, with early progression as of the 17th day of life that required the performance of a right systemic pulmonary anastomosis, which was repeated in the left side at the age of 9 months. He has remained stable since then, with mild cyanosis and dyspnea, and delayed physical development. His physical examination revealed no respiratory distress, cyanosis +/++, and normal pulses. Blood pressure was 100/60 mmHg, heart rate was 71 bpm, oxygen saturation was 85%, weight was 27 kg, and height was 138 cm. The aorta was not palpable in the suprasternal notch. In the precordium, mild systolic impulses on the left sternal border could be observed, and a slightly forceful apex impulse was palpable at the 4th left intercostal space, limited to two fingertips. The first heart sound was accentuated, more intense in the mitral area than in the tricuspid area, and the second heart sound was accentuated and single in the pulmonic area, and was also more intense in the mitral area. A grade 3 protosystolic click was present in all the precordium. A grade 1-2/6 continuous heart murmur could be auscultated in the 2nd, 1st, and 3rd left intercostal spaces. The liver was not palpable. The electrocardiogram showed a sinus rhythm and signs of right ventricular overload with a 10 mm R wave in V1, and a positive T wave in this lead. Q wave was absent in left precordial leads. These elements may suggest left ventricular overload, located at the right. SÂQRS: + 120 o, SÂT: -30 o.

arquivos brasileiros de cardiologia

Caso 4/2006: adolescente de treze anos com ventrículo único esquerdo, discordância ventrículo-arterial com aorta à esquerda, estenose pulmonar e shunt sistêmico pulmonar prévio