An echocardiogram on a one day-old infant with refractory hypoxemia finds no evidence of congenital heart disease but reveals right-to-left shunting through a patent ductus arteriosus, tricuspid valve regurgitation and an enlarged right ventricle. Which of the following is the most likely problem?

The answer is persistent pulmonary hypertension of the newborn (PPHN).

Explanation:

Persistent pulmonary hypertension of the newborn (PPHN) can be defined as situation in which there is a failure of the normal circulatory transition that takes place after birth. It is a syndrome that is characterized by marked pulmonary hypertension that causes hypoxemia secondary to right-to-left shunting of blood at the foramen ovale and ductus arteriosus.

Persistent pulmonary hypertension of the newborn (PPHN) occurs when the pressure in the blood vessels supplying the lungs of a newborn baby remains high after birth. The pulmonary arteries are narrowed, reducing blood flow through the lungs and causing the pressure to be naturally high. What this means is that PPHN happens when a newborn's circulation system doesn't adapt to breathing outside the womb because while in the womb, the fetus receives oxygen through the umbilical cord, therefore, the lungs need little blood supply.

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