Use of Saline Echocardiography in Diagnosing Functional Pulmonary Atresia in A Newborn

This case report details a neonate with functional pulmonary atresia (FPA), initially misdiagnosed prenatally as anatomical pulmonary atresia. Fetal findings included cardiomegaly, severe tricuspid regurgitation, and right ventricular dysfunction. Postnatally, the absence of antegrade pulmonary flow raised concern for anatomical atresia. However, saline contrast echocardiography definitively confirmed patent pulmonary valves, establishing the diagnosis of transient FPA secondary to severe functional right heart impairment without anatomical atresia of the pulmonary valves. This case highlights the potential value of the saline contrast test in distinguishing FPA from anatomical pulmonary atresia, which can help avoid unnecessary interventions. It also provides additional insight into the natural history of prenatally suspected isolated FPA.