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A three-month-old white male infant with history of fatigue while breast-feeding since birth, which had gotten worse over the last 60 days; restlessness; difficulty in gaining weight (he had put on only 240 g in the previous month); and, sometimes, dry cough. On physical examination he had dyspnea ++, normal pulses, and weighed 4440 g. No cyanosis was observed. The aorta was not palpable. Chest examination showed mild impulses along the left sternal border and a valve and muscular apical impulse +/++ located at the 4th left intercostal space limited by the breadth of two fingers. Heart sounds were loud and most intense in the tricuspid area. The third sound was heard in the mitral area. A harsh systolic ejection murmur+ was heard in the 3rd, and 4th left intercostal spaces, irradiating to the right sternal border. The liver was palpable 4 cm from the right costal margin and xiphoid process.

arquivos brasileiros de cardiologia

Caso 3/2007: lactente de três meses com criss-cross heart, discordância atrioventricular e dupla via de saída de ventrículo direito, sem estenose pulmonar