A 5-year-old girl with cyanotic congenital heart disease has a hugely enlarged cardiac silhouette on chest X-ray described as 'wall to wall', with reduced pulmonary vascular markings. Her mother received psychiatric medication during the first trimester. Which medication is implicated?
- A Sodium valproate
- B Lithium carbonate ✓
- C Carbamazepine
- D Paroxetine
Correct answer: B. Lithium carbonate
Explanation
First trimester lithium exposure is associated with Ebstein anomaly, characterized by downward displacement of the tricuspid valve producing atrialization of the right ventricle. The massive right atrial enlargement creates the 'wall to wall' heart on chest X-ray, typically with oligaemic lung fields. Valproate and carbamazepine are linked with neural tube defects, and paroxetine carries a weak signal for septal defects, not Ebstein anomaly.
Reference: Park's Pediatric Cardiology for Practitioners, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.