CLINICAL HISTORY.—This 10-day-old white girl was a product of a full term spontaneous delivery with a birth weight of 3.5 kg (7 lb 11 oz). Within 24 hours of birth, the baby became cyanotic and tachypneic. Even with digitalis and antibiotics, the symptoms progressed so that the infant was referred to Yale-New Haven Hospital.
Physical findings revealed a cyanotic baby in moderate distress with chest retractions. The heart sounds were of good quality with a quadruple rhythm. No heart murmur was present. Coarse rales were heard at both lung bases posteriorly. The liver was pulsatile and 4 cm below the right costal margin.
The electrocardiogram demonstrated right axis deviation ( +120°) and right ventricular hypertrophy. The oxygen saturation of the arterial blood was 68%.
Denouement and Discussion
Anomalous Pulmonary Venous Return
Clinically, the diagnosis may be suggested by early neonatal cyanosis, respiratory distress, evidence of pulmonary edema, pulsatile enlarged liver, accentuated