| Coarctation of Aorta |
- Strong upper extremity pulses + weak/absent lower extremity pulses
- Blood pressure differential: arm > leg
- Duct-dependent systemic circulation (lower body)
- Presents days 1-7 as ductus closes
- NO murmur (or soft ejection murmur)
- Symptoms worse with feeds
- Treat immediately with prostaglandin E1
- Surgical repair or balloon angioplasty
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| VSD |
- Holosystolic (pansystolic) murmur at left lower sternal border
- Left-to-right shunt → pulmonary overcirculation
- Failure to thrive (from increased metabolic demand)
- Usually presents weeks to months (after PVR drops)
- Equal brachial and femoral pulses
- Rales from pulmonary edema
- Palpable thrill if large
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| HLHS |
- Hypoplastic left heart + ascending aorta
- ALL pulses weak (not differential — no upper/lower discrepancy)
- Ductal-dependent systemic circulation
- Profound shock when PDA closes
- Single S2 (only pulmonic component)
- Norwood procedure (staged palliation)
- Often detected prenatally on anatomy scan
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| TGA |
- Parallel circulations: aorta from RV, PA from LV
- Profound cyanosis from birth
- O2 does NOT improve with 100% FiO2 (parallel circuits)
- Single loud S2
- No significant murmur
- Egg-on-string CXR (narrow mediastinum)
- PGE1 + balloon atrial septostomy (Rashkind) → arterial switch (Jatene)
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