Differential diagnosis of congenital heart disease in the first 3 months of life Significance of a superior ( left ) QRS axis ELLIOT

Shinebourne, E. A., Haworth, S. G., Anderson, R. H., and Ulgur, A. (1974). Archives of Disease in Childhood, 49, 729. Differential diagnosis of congenital heart disease in the first 3 months of life: significance of a superior (left) QRS axis. The ECGs of 473 infants under the age of 3 months who were referred to a paediatric cardiological unit were analysed; 47 (10%) of the ECGs showed a superior axis (dominantly negative deflection S wave, in lead aVF). Of these, the majority of noncyanosed patients with plethora on chest x-ray proved to have either an atrioventricular canal defect or a large ventricular septal defect. When cyanosis and pulmonary plethora on x-ray were present, tricuspid atresia with increased pulmonary flow (types Ic or IIc) or d-transposition with ventricular septal defect accounted for most cases. With cyanosis and pulmonary oligaemia on x-ray, tricuspid atresia (types Ia and b) or pulmonary atresia with ventricular septal defect accounted for all cases. Finally, 2 patients with superior axis presenting in a shocked condition were found to exhibit the hypoplastic left heart syndrome. Recognition of superior axis in the ECG provides a useful diagnostic aid in congenital heart disease in early infancy.