A cyanotic 4-day-old neonate develops worsening central cyanosis that improves with 100% oxygen administration (hyperoxia test PaO2 rises from 35 to 55 mmHg). Echocardiography shows the aorta arising from the right ventricle and pulmonary artery from the left ventricle. What is the DEFINITIVE treatment?
- A Balloon atrial septostomy followed by arterial switch operation ✓
- B Blalock-Taussig shunt
- C Fontan procedure
- D Pulmonary artery banding
Correct answer: A. Balloon atrial septostomy followed by arterial switch operation
Explanation
This is Transposition of the Great Arteries (TGA), the most common cyanotic CHD presenting in the neonatal period. The parallel circulations are not compatible with life without mixing; emergency balloon atrial septostomy (Rashkind procedure) creates an ASD to allow mixing. Definitive repair is the arterial switch operation (Jatene procedure) performed within the first 2 weeks of life before the left ventricle de-trains to the lower pulmonary pressure.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.