ABSTRACT
These may present in three age groups.
In the early newborn period, heart failure and respiratory difficulty are usually caused by obstructive lesions of the left heart (e.g. coarctation of the aorta, hypoplastic left heart syndrome and occasionally aortic stenosis). Both the femoral and brachial pulses must be positively identified in order to exclude critical left heart obstruction. Pulses once present may disappear after a few days when the arterial duct closes, so suspicious cases should be re-examined. Circulatory collapse with metabolic acidosis and hepatomegaly may be the presenting feature, but there is usually a history of feeding difficulty for 6–8 h.
After a few weeks left-to-right shunts may lead to feeding difficulty, tachypnoea with subcostal recession and heart failure with liver enlargement. There may be disproportionate weight gain due to fluid retention. Cardiac enlargement is invariably present in both groups and is best seen on CXR.
In the premature infant, especially those less than 36 weeks, the ductus arteriosus may fail to close, particularly if there is respiratory distress syndrome. A systolic murmur is usually heard and the pulse is collapsing.
