Abstract
A case of triple shunt (ASD + VSD + PDA), associated with anocutaneous fistula, is presented. The patient was born at 40 weeks of gestation with normal delivery. Birth was 2800g. After cutback procedure on the 2nd postnatal day, the patient gradually fell in the condition of respiratory distress early in the neonatal period, and needed a mechanical ventilation. Association of ASD, VSD and PDA was correctly diagnosed on the third echoic examination of the heart. Cardiac catheterization revealed prominent pulmonary hypertension with a large amount of shunt flow (Pp/Ps = 1.0, Qp/Qs = 3.6, Rp/Rs = 0.28). Ligation of PDA, direct closure of ASD and patch closure of VSD were simultaneously performed on the 33rd postnatal day. Postoperative course was uneventful. Association of triple shunt with imperforate anus is so far reported only in two Jopanese literatures. Triple shunt is a fatal combination of the cardiac anomalies, because cardiac failure and resperatory distress develop in the neonatal period. In the literature, triple shunt is associated with a variety of pediatric surgical diseases, even though its occurrence is rare. Triple shunt should be added to a list of the differential diagnosis in cases with cardiac failure and respiratory distress in the neonatal period. Repetitive echoic examinations are recommended for an accurate diagnosis and proper operative intervention.
