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After birth, he developed severe respiratory failure, congestive heart failure and airway obstruction because an enlarged left atrium from severe mitral regurgitation compressed the distal left main bronchus. There is limited experience in surgical management of this condition in Thailand, and the patient\u2019s mitral valve was too small for replacement. Therefore, he was treated with medication to control heart failure and supported with positive pressure ventilation to promote growth. We have followed the patient until the current time of writing this report at the age of 2 years, and his outcome is favourable regarding heart failure symptoms, airway obstruction, growth and development. This case describes a challenging experience in the non-surgical management of MA with severe regurgitation, which presented at birth.<\/jats:p>","DOI":"10.1136\/bcr-2023-259272","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T19:00:25Z","timestamp":1718218825000},"page":"e259272","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Challenges of managing anomalous mitral arcade with severe mitral regurgitation and hydrops fetalis in infants"],"prefix":"10.1136","volume":"17","author":[{"given":"Tienake","family":"Trisauvapak","sequence":"first","affiliation":[{"name":"Pediatrics, Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Bang phli, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitiroj","family":"Bongkotwilawan","sequence":"additional","affiliation":[{"name":"Pediatrics, Chakri 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