A 6-year-old boy with Down syndrome presents to the clinic with progressive dyspnea on exertion over the past 6 months. His mother reports he can no longer keep up with peers during play. Vital signs: HR 115 bpm, RR 30, BP 92/58, SpO2 91% on room air. Physical examination reveals a hyperdynamic precordium with prominent right ventricular heave, single loud S2 with accentuated pulmonary component, and a holosystolic murmur best heard at the left lower sternal border. No cyanosis is noted. Chest X-ray shows increased pulmonary vascular markings, pulmonary artery prominence, and right atrial enlargement. Which of the following is the most likely diagnosis?
- A)Atrioventricular septal defect with early pulmonary hypertensionGABARITO
- B)Tetralogy of Fallot with progressive right ventricular outflow tract obstruction
- C)Atrioventricular septal defect with established Eisenmenger syndrome
- D)Partial anomalous pulmonary venous return to the superior vena cava
- E)Patent foramen ovale with secundum-type atrial septal defect
Explicação
Atrioventricular septal defect (AVSD) is the most common cardiac lesion in Down syndrome (30-40% of cardiac cases). The clinical presentation shows accentuated pulmonary component of S2, holosystolic murmur (AV valve regurgitation), right ventricular heave, an... Ver explicação completa e trilha adaptativa →