A 1-day-old male infant born at term presents to the neonatal intensive care unit with severe cyanosis and respiratory distress. Vital signs show heart rate 168/min, respiratory rate 70/min, oxygen saturation 76% on room air, and blood pressure 98/62 mmHg in the right arm and 58/38 mmHg in the left arm. Physical examination reveals diminished femoral pulses bilaterally, a normal S2, and no murmur appreciated on auscultation. Chest radiograph shows a '3-sign' appearance of the aorta with pulmonary edema. The ductus arteriosus remains patent on echocardiography. Which of the following is the most likely diagnosis?
- A)Hypoplastic left heart syndrome with right-to-left shunting across the foramen ovale
- B)Coarctation of the aorta with ductal-dependent systemic circulationGABARITO
- C)Interrupted aortic arch with associated chromosome 22q11 deletion
- D)Critical aortic stenosis with left ventricular dysfunction
- E)Transposition of the great arteries with patent ductus arteriosus
Explicação
Coarctation of the aorta (CoA) is the most likely diagnosis. The key diagnostic features are: (1) severe systolic blood pressure differential between upper (98/62) and lower (58/38) extremities—classic for proximal aortic narrowing; (2) absent/diminished femor... Ver explicação completa e trilha adaptativa →