An infant born to a mother who received lithium throughout the first trimester is found to have cyanotic heart disease. Echocardiography shows downward displacement of the septal leaflet of the tricuspid valve into the right ventricle with atrialised right ventricle. This congenital lesion is:

• A Ebstein anomaly ✓
• B Transposition of the great arteries
• C Hypoplastic left heart syndrome
• D Total anomalous pulmonary venous connection

Explanation

First trimester lithium exposure is classically associated with Ebstein anomaly, a malformation in which the tricuspid valve leaflets are displaced downward, atrialising part of the right ventricle. Although the absolute risk is low, this association is the reason lithium is generally avoided or substituted early in pregnancy where feasible. The other listed lesions have no established link with lithium and are instead linked to maternal diabetes, prostaglandin exposure and other factors.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.