Paeds Vivas · cardiology
Transposition of the great arteries — branching viva
Branching viva on transposition of the great arteries: the parallel-circulation problem in the neonate, the resuscitation trio of prostaglandin E1, balloon atrial septostomy and arterial switch, the surgical decision-making for the VSD and LVOTO subtypes, and the long-term legacy of the atrial-switch era.
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Prompt
Postnatal ward: a term infant at six hours of life is centrally cyanosed but feeding and alert, with little respiratory distress. The lower limbs are pinker than the hands. A saturation of 72 per cent does not improve on one hundred per cent oxygen, and the chest X-ray shows a narrow mediastinum with an egg-shaped cardiac silhouette. The examiner asks: what is the lesion, why is the infant 'comfortably blue', what is your immediate management, and what is the definitive plan — then branches to the septostomy decision, the coronary question, and finally to an adult who had an atrial-switch repair presenting with atrial flutter.
Opening question
A six-hour-old term infant is cyanosed, alert, feeding, and breathing comfortably, with a saturation of 72 per cent that does not rise on one hundred per cent oxygen and a chest X-ray showing an egg-on-a-string silhouette. What is the lesion, and why does the infant look 'comfortably blue' rather than distressed? [2] [1]
References4ShowHide
- [1]Carter E; Rogers LS Transposition of the great arteries: anatomy, physiology and surgical outcomes today. Curr Opin Pediatr, 2025.PMID 40820908
- [2]Martins P; Castela E Transposition of the great arteries. Orphanet J Rare Dis, 2008.PMID 18851735
- [10]Singh Y; Mikrou P Use of prostaglandins in duct-dependent congenital heart conditions. Arch Dis Child Educ Pract Ed, 2018.PMID 29162633
- [4]Moe TG; Bardo DME Long-term Outcomes of the Arterial Switch Operation for d-Transposition of the Great Arteries. Prog Cardiovasc Dis, 2018.PMID 30227186