Differential Clubbing and a Triad of Patent Ductus Arteriosus, Ventricular Septal Defect and Supravalvular Ring Mitral Stenosis: A Case Report

C. O. Osagie, Okechukwu S. Ogah, Akinyemi Aje, A, A. Adebiyi, A. M. Adeoye, O. O. Oladapo, B. E. Adebayo

Abstract

It is not uncommon for congenital heart defects to occur in clusters.
Those involving a right to left heart shunt commonly cause cyanosis
and finger clubbing. Differential clubbing involving only the lower
limb digits is a strong pointer to the presence of patent ductus
arteriosus with reversal of shunt.
We report a case of 25-year-old man with effort intolerance and
differential clubbing. He was found to have the uncommon triad of
patent ductus arteriosus, ventricular septal defect and supravalvular
ring mitral stenosis.
The presence of differential clubbing on a background of patent
ductus arteriosus usually indicates a reversal of shunt and negates
surgical intervention. This general rule may however not apply with
co-existing mitral stenosis as the elevated pulmonary pressure may be
predominantly post capillary. The finding of mitral stenosis in a
patient with patent ductus arteriosus and differential limb clubbing
may signify a good prognostic surgical outcome.
WAJM 2024; 41 (1): 87 - 91.

KEYWORDS: differential clubbing, patent ductus arteriosus,
ventricular septal defect, supravalvular ring mitral stenosis.