Snapshot A neonatal boy is born to a 38-year-old mother with gestational diabetes. He seems to be tolerating feeds; however, in the first few days of life, his mother notices that his lips turn blue whenever he cries. It resolves when he stops crying. On physical exam, the physician notes central cyanosis while crying. The physician puts him in a knee-to-chest position, without any effect. Echocardiography is obtained, and he is found with a large ventricular septal defect and transposition of the great vessels. Introduction Clinical definition login to view 1 more bullet Etiology Failure of neural crest cells to migrate Pathogenesis login to view 6 more bullets Associated conditions login to view 2 more bullets Epidemiology Demographics login to view 3 more bullets Risk factors login to view 3 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 5 more bullets Imaging Radiography login to view 8 more bullets Echocardiography login to view 6 more bullets Differential Tetralogy of Fallot login to view 2 more bullets Diagnosis Making the diagnosis login to view 2 more bullets Treatment Medical login to view 5 more bullets Operative login to view 8 more bullets Complications Heart failure Sudden cardiac death Prognosis Infants experience severe cyanosis and tachypnea as the ductus arteriosus closes in the newborn period Patients with large VSDs may not present with severe cyanosis login to view 1 more bullet