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Nirav Shastri, MD

Arch Pediatr Adolesc Med. 2007;161(7):711.

A term baby was born by spontaneous vaginal delivery to a gravida 5, para 5 mother. His Apgar score was 7 after 1 minute. At 5 minutes, the score was 8 because of the presence of acrocyanosis and low heart rate. He was appropriate for gestational age with a birth weight of 3417 g, length of 51.7 cm, and head circumference of 35.5 cm. On examination, there was a bifid thumb with duplication of the distal phalanx on the right hand (Figure 1). On auscultation, an ejection systolic murmur grade 2/6 on the left sternal border was heard. Electrocardiography showed bradycardia with a heart rate of 93 beats/min. Echocardiography revealed a secundum atrial septal defect measuring 1.33 cm (Figure 2). There was no family history of any limb or heart defects.

View larger version (83K): [in this window] [in a new window] [as a PowerPoint slide]   Figure 1. Bifid thumb on right hand.

View larger version (78K): [in this window] [in a new window] [as a PowerPoint slide]   Figure 2. Echocardiogram (subcostal view) showing the atrial septal defect. HR indicates heart rate.

What is your diagnosis?

Author Affiliation: Department of Pediatrics, University of Kansas Medical Center, Kansas City.

SECTION EDITOR: ALBERT C. YAN, MD; ASSISTANT SECTION EDITOR: SAMIR S. SHAH, MD

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