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?

  1. A)Hypoplastic left heart syndrome with right-to-left shunting across the foramen ovale
  2. B)Coarctation of the aorta with ductal-dependent systemic circulationGABARITO
  3. C)Interrupted aortic arch with associated chromosome 22q11 deletion
  4. D)Critical aortic stenosis with left ventricular dysfunction
  5. 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 →

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