Clinical History.—A 1-month-old girl was admitted to the hospital with a history of increasing tachypnea, dyspnea, and moderate cyanosis for two weeks. She weighed 2,869 gm (6 lb 5 oz) at birth, and the pregnancy was uneventful.
Physical Examination.—She now weighed 3,175 gm (7 lb). There was moderate cyanosis of the lips, and the respiratory rate was 50 breaths per minute. The respirations were, for the most part, abdominal. Heart sounds were of fair quality and heard best in the right side of the chest. There were coarse rales heard in the right base.
The electrocardiogram was interpreted to show sinus rhythm with a rate of 175/min. There was right axis deviation. The hemoglobin value was 14.5 gm/100 ml; hematocrit, 42%. The specific gravity of the urine was 1.001, and 5 to 10 leukocytes were seen per high power field.
Roentgenograms of the chest were obtained (Fig 1