A 2-day-old neonate develops sudden severe cyanosis, tachycardia, and circulatory collapse. Echocardiography reveals transposition of the great arteries (TGA) with intact ventricular septum. Immediate stabilization is best achieved by:

• A Emergency arterial switch operation
• B Blalock-Taussig shunt placement
• C High-flow oxygen administration alone
• D Intravenous prostaglandin E1 and balloon atrial septostomy ✓

Explanation

In TGA with intact ventricular septum, systemic and pulmonary circulations are in parallel; survival depends on mixing at atrial level (PDA or ASD). PGE1 maintains ductal patency to increase mixing, and balloon atrial septostomy (Rashkind procedure) creates an adequate interatrial communication for stabilization. The arterial switch operation (Jatene) is the definitive repair but requires haemodynamic stabilization first. BT shunt is used for lesions with restricted pulmonary blood flow, not TGA. High-flow oxygen alone will close the ductus.

Reference: Ghai Essential Pediatrics, 10th ed.

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Written and medically reviewed by the StethoPrep medical team.