A newborn is diagnosed with transposition of the great arteries (TGA) on echocardiography. The baby is severely cyanotic with an O2 saturation of 55%. The most critical intervention to maintain life until corrective surgery is:

• A Prostaglandin E1 infusion to maintain ductal patency
• B Emergency Blalock-Taussig shunt
• C Balloon atrial septostomy (Rashkind procedure) ✓
• D Immediate arterial switch operation

Explanation

In TGA with intact ventricular septum, survival depends on mixing of the two parallel circulations. If the foramen ovale or ductus arteriosus is restrictive, balloon atrial septostomy (Rashkind procedure) creates a large atrial septal communication to improve mixing and oxygenation as a bridge to definitive surgery. PGE1 is used to maintain ductal patency in many cyanotic lesions, but in TGA with a closed foramen ovale, the priority is atrial septostomy. Arterial switch is the definitive repair, ideally done within 2 weeks.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.