Congenital Disorders I

Cardiovascular System


{"ops":[{"insert":"A healthy 9-month-old boy is brought to the physician for a well-child examination. He has no history of serious illness. He has been feeding and growing well. Pulse oximetry on room air shows an oxygen saturation of 98%. He is pink in color. The lungs are clear to auscultation. A grade 3\/6 systolic ejection murmur is heard along the left middle and upper sternal border. S2 is widely split and does not vary with respiration. Pulses are strong in all extremities. X-rays of the chest are normal. Which of the following is the most appropriate next step in management?"},{"insert":"\n"}]}

Background

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(A)

Reassurance
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(B)

Yearly cardiology follow-up
{"ops":[{"insert":"\n"}]}

(C)

Intravenous indomethacin
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(D)

Percutaneous transcatheter correction
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(E)

Surgical correction
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References

{"ops":[{"insert":"MAHMOUD H, NICOLESCU AM, FILIP C, NICOLAE G, DUIC\u0103 G, B\u0103LGR\u0103DEAN M, CINTEZ\u0103 EE. Complex atrial septal defect closure in children. Rom J Morphol Embryol [online] 2019, 60(1):49-57 [viewed 08 July 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/31263827"},{"insert":"\n","attributes":{"list":"ordered"}},{"insert":"Bernstein, Daniel. Ostium Secundum Defect [online]. Nelson Textbook of Pediatrics, 2020 [viewed 08 July 2019]. Available from: https:\/\/www.us.elsevierhealth.com\/nelson-textbook-of-pediatrics-2-volume-set-9781455775668.html"},{"insert":"\n","attributes":{"list":"ordered"}},{"insert":"RAO PS, HARRIS AD. Recent advances in managing septal defects: atrial septal defects F1000Res [online] 2017 Nov 22:2042 [viewed 08 July 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5701442"},{"insert":"\n","attributes":{"list":"ordered"}},{"insert":"MARTIN SS, SHAPIRO EP, MUKHERJEE M. Atrial Septal Defects \u2013 Clinical Manifestations, Echo Assessment, and Intervention Clin Med Insights Cardiol [online] 2015 Mar 23, 8(Suppl 1):93-98 [viewed 08 July 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC4373719"},{"insert":"\n","attributes":{"list":"ordered"}},{"insert":"FRAISSE A, LATCHMAN M, SHARMA SR, BAYBURT S, AMEDRO P, DI SALVO G, BARUTEAU AE. Atrial septal defect closure: indications and contra-indications. J Thorac Dis [online] 2018 Sep, 10(Suppl 24):S2874-S2881 [viewed 08 July 2019] Available from: http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/30305947"},{"insert":"\n","attributes":{"list":"ordered"}}]}

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