Approach to congenital heart diseases (cyanotic) Quiz: Ace Your Exams

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A 3300-g (7.2-lb) newborn boy is delivered at term and is noted to be cyanotic at birth. The parent did not have prenatal care during her pregnancy and has a past medical history of bipolar disorder for which she takes lithium inconsistently. Temperature is 36.8°C (98.2°F), heart rate is 210/min, respirations are 70/min, blood pressure is 65/36 mmHg, and oxygen saturation is 75% on room air. Physical examination reveals cyanosis and intercostal and subcostal retractions. Cardiac examination reveals a holosystolic murmur at the lower left sternal border and a gallop. Abdominal examination is significant for a liver edge that is 5 cm below the costal margin. Chest x-ray shows massive cardiomegaly with a “box-shaped” appearance of the heart. Which of the following findings on the echocardiogram will confirm the most likely diagnosis?

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Aorta arising from the right ventricle

Pulmonary veins draining to the right atrium

Hypoplastic left atrium

Overriding aorta

Downward displacement of the tricuspid valve into the right ventricle