The blues

A 20 year old refugee presents with recurrent episodes of exertional dyspnea, palpitations and easy fatiguability since childhood. He had not undergone evaluation in his native country.

His family history is unremarkable, and he is not on any medications.

Select Relevant Investigations
Full blood count

Performed

WBC/DC: 7,000/mm3

Hb: 18.2 g/dl
Hct (PCV): 60%

Platelets: 300,000/mm3
Chest X-Ray

Performed

The x-ray reveals oligemic lung fields and a boot-shaped heart.
ECG

Performed

The ECG shows P-pulmonale, right axis deviation, and a right bundle branch block.
Echocardiography

Performed

The findings include a 2 cm membranous VSD with a right to left shunt; a 45% aortic override with a normal aortic diameter; right ventricular hypertrophy, right atrial dilatation and infundibular stenosis; a small left ventricle; and an ejection fraction of 56%.

Select Relevant Management
Oxygen
Bronchodilators
Pulmonary valve repair
Surgical correction