A 4-day-old neonate develops progressive cyanosis, tachypnea, and poor feeding. Chest X-ray shows an 'egg on a string' appearance with a narrow mediastinum. Echocardiography confirms the diagnosis. Prostaglandin E1 infusion is started. Which intervention is performed as an emergency palliation before definitive repair?
- A Blalock-Taussig (BT) shunt
- B Pulmonary artery banding
- C Rashkind balloon atrial septostomy ✓
- D Waterston shunt
Explanation
The 'egg on a string' (egg on its side) chest X-ray appearance with a narrow mediastinum is pathognomonic of transposition of the great arteries (TGA). In TGA, the parallel circulations (pulmonary and systemic) are life-incompatible without mixing; PGE1 maintains a patent ductus arteriosus for some mixing. For adequate inter-atrial mixing to sustain oxygenation, Rashkind balloon atrial septostomy (BAS) is performed as an emergency palliative procedure under echocardiographic or fluoroscopic guidance to enlarge the foramen ovale. Definitive repair is the arterial switch operation (Jatene procedure) within the first 2 weeks of life. BT shunt is for cyanotic lesions with reduced pulmonary blood flow (e.g., TOF), not TGA.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.