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G414(P) Unusual cause of cyanosis in a newborn
  1. N Salameh1,
  2. P Nair1,
  3. L Salamehova2
  1. Paediatrics, Bedford Hospital, Bedford, UK
  2. Neonates, Bradford Royal Infirmary, Bradford, UK


Introduction Chiari’s network is a remnant of the eustachian valve located in the right atrium. Incomplete involution of the fetal sinus venosus valves results in ‘redundant’ Chiari’s network, which may compromise cardiovascular function [1].

Case Report A male baby was delivered at 39 weeks of gestation by spontaneous vaginal delivery. Baby was born macrosomic with birth weight of 5.29 Kg. Baby was born in poor condition and needed cardiopulmonary resuscitation with heart rate first recorded at two and a half minutes of life and spontaneous breathing first recorded at 25 min of life. Baby was ventilated briefly and then extubated to nasal cannula oxygen. No therapeutic cooling was indicated.

He continued to require oxygen as his oxygen saturation levels were in late 80’s without oxygen supplementation. His cardiovascular and respiratory examination was otherwise unremarkable. His chest x-ray was reported to be normal. Echocardiogram showed a prominent Chiari network within the right atrium, partly occluding the tricuspid valve orifice which was causing functional impairment of the right ventricle filling and a reversal of flow across the patent foramen ovale. Overall, there was good biventricular function and no other congenital anomalies noted.

After the results of echocardiogram, oxygen was withdrawn on day 14 of life and the baby was discharged two days later. Follow up scans showed improvement in the right ventricular filling and improving saturations.

Discussion Chiari network is usually considered to be a harmless entity[2]. However it is important to recognise that it can sometimes cause right ventricular inflow obstruction and a right to left flow across an atrial septal defect causing low saturations. This usually improves over the first few weeks of life with improving right ventricular compliance[3]. These babies therefore could be managed in a district general hospital without a need for transfer to a tertiary centre and appropriate counselling could be provided to parents as the outcome is usually positive and surgical intervention is usually not required.

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