A neonate has massive cardiomegaly with grossly diminished pulmonary vascular markings on chest X-ray. Echocardiography shows a hugely dilated right atrium, apical displacement of the septal tricuspid leaflet, and an atrialized portion of the right ventricle. On taking further history, which prenatal exposure is MOST relevant?
- A Maternal alcohol consumption
- B Maternal phenytoin intake
- C Maternal lithium carbonate intake ✓
- D Maternal warfarin intake in the first trimester
Correct answer: C. Maternal lithium carbonate intake
Explanation
The findings describe Ebstein anomaly, defined by apical displacement of the tricuspid septal leaflet with atrialization of the right ventricle. Maternal lithium exposure in the first trimester is the classic drug association quoted in standard texts, although the absolute risk is low. Warfarin embryopathy causes nasal hypoplasia and stippled epiphyses, phenytoin causes fetal hydantoin syndrome, and alcohol associates mainly with septal defects, so none of these fit Ebstein anomaly.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.