Snapshot A neonatal boy is found to be cyanotic a few hours after delivery. The mother noticed the neonate turning blue when crying and feeding. The boy was born via a spontaneous vaginal delivery without any complications and to a 30-year-old mother. The mother received inconsistent prenatal care throughout her pregnancy. Physical examination is significant for a harsh systolic ejection murmur. A chest radiograph is performed and demonstrates a "boot-shaped" heart. Introduction Clinical definition login to view 5 more bullets Epidemiology Demographics login to view 2 more bullets Risk factors login to view 2 more bullets Etiology Conotruncal abnormality from the failure of neural crest cells to migrate Pathogenesis login to view 5 more bullets Associated conditions login to view 2 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 5 more bullets Imaging Radiography login to view 7 more bullets Echocardiogram login to view 7 more bullets Studies Electrocardiogram login to view 3 more bullets Making the diagnosis login to view 2 more bullets Differential Transposition of the great vessels login to view 3 more bullets Truncus arteriosus login to view 3 more bullets Treatment Medical login to view 10 more bullets Operative login to view 6 more bullets Complications Thrombosis Infective endocarditis Heart failure Prognosis Severity of symptoms depends on the severity of right ventricular outflow obstruction Long-term survival is good with surgical repair