Abstract

Asymmetrical Septal Hypertrophy: A rare case of respiratory distress in an Infant of a Diabetic Mother

Introduction: Cardiomyopathy is a disease that affects the myocardium and causes mechanical or electric dysfunction. Hypertrophic cardiomyopathy comprises of various cardiac components such as thickening of ventricular walls, hypertrophy of inter-ventricular septum thereby resulting in sub-aortic stenosis, systolic and/or diastolic dysfunction. This cardiac complication is a known but rare entity in infants of diabetic mothers wherein the clinical presentation ranges from being asymptomatic to respiratory distress to congestive cardiac failure. Incidence of Congenital Heart Disease in infants of Diabetic Mothers is 5% and the percentage of symptomatic HOCM babies is 12%. Case Report: We report a term neonate, born to a G2P2L2 mother with Gestational Diabetes Mellitus with poor glycemic control, presenting with respiratory distress manifesting as silent tachypnea at 24 hours of life, diagnosed as Asymmetrical Septal Hypertrophy on 2D-Echo, treated successfully with Propranolol and showed resolution of hypertrophy in follow-up echocardiography. Conclusion: The Fetal Hyperinsulinemia is responsible for increase in synthesis and deposition of fat and glycogen in the myocardial cells which explains the cardiac hypertrophy. Due to increase in the thickness of the Interventricular Septum, there is Left Ventricular Hypertrophy and during systole, the systolic anterior motion of the anterior leaflet (SAM) of the aortic valve is elongated. Therefore, due to this obstruction of the orifice by the Aortic Valve, there is reversal of blood flow clinically manifesting as Silent Tachypnea. Symptomatic babies are treated with Oral Propranolol which act by improving left ventricular outflow obstruction.

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