Abstract
A growth-restricted baby boy was born at term with a birthweight of 1.9 kg. He was given NICU care for nine days. The echocardiographic studies done for respiratory distress and murmurs revealed left-to-right shunts at atrial, ventricular, and ductal levels and severe pulmonary hypertension. However, the pulmonary artery pressure values were not available. Financial constraints did not permit surgery. He presented at the Primary Health Centre for shortness of breath and growth failure at four-and-a-half years of age. The child received sildenafil for pulmonary hypertension with a "treat and repair" approach. The child is steadily improving in breathing, outdoor games, and schooling. The pulmonary pressures were still high (60 mm) on repeat echocardiographic studies performed after 18 months of sildenafil treatment. Six-monthly echo studies are planned to guide the future course of action.