NMS Q&A Family Medicine

66 NMS Q&A Family MedicineVSD (thus the loud murmur typical of that lesion) beginshunting unoxygenated blood into the right ventricle, andmixed systemic oxygenated and unoxygenated blood goesinto the systemic circulation. When transposition is associatedwith ASD, there is only a soft murmur, but cyanosisoccurs at about the same time. Although an isolated ASDcould be associated with cyanosis, the cyanosis would notoccur in infancy. Rarely in adulthood, pulmonary hypertensioncan develop, which then can change the shunt froma right to left and produce cyanosis, but this is much lesslikely to be seen in ASD as it is in VSD or if a patent ductuspersists. Whether associated with ASD or VSD, cyanosis isworse when there is also PS. Hypoplastic left heart is notcharacterized by a shunt and therefore is not associatedwith cyanosis. Transposition of the great vessels occurs inmale to female infants 3:1 and tends to occur in larger thanaverage-sized babies. Repair through reversal of the greatvessels surgically must occur within the first 7 days.ReferencesBricker JT , Anderson JC . Cardiovascular problems in children. In: Rudy DR , Kurowski K , eds. Family Medicine:House Officer Series . Baltimore, MD : Williams & Wilkins ;1997 : 133 – 144 .Bashore TM , Granger CB , Hranitzky P , Patel MR . Heart disease .In: Current Diagnosis and Treatment. McGraw Hill-Lange;2010 : 294 – 387 .Thilo EH , Rosenberg AA . The newborn infant . In: May WW ,Levin MJ , Sondheimer JM , Deterding RR , eds. CurrentPediatric Diagnosis and Treatment , 19th ed . McGraw Hill ;2010 : 1 – 60 .Sondheimer HM , Darst JR , Shaffer EM , Miyomoto SD . Cardiovasculardiseases . In: May WW , Levin MJ , Sondheimer JM ,Deterding RR , eds. Current Pediatric Diagnosis and Treatment ,19th ed . McGraw Hill ; 2009 .