Review Question - QID 109381

A newborn boy is evaluated in the hospital nursery 24 hours after birth for cyanosis. The patient was born at 38 weeks of gestation to a 36-year-old gravida 3 mother via cesarean section for fetal distress. The patient’s mother received inconsistent prenatal care. The patient’s APGAR evaluation was notable for acrocyanosis at both 1 and 5 minutes of life. The patient’s mother denies any family history of congenital heart disease. The patient’s father has a past medical history of hypertension. This patient also has an older sibling who was recently diagnosed with autism spectrum disorder. The patient’s birth weight was 3180g (7 lb 0 oz). In the hospital nursery, his temperature is 99.3°F (37.4°C), blood pressure is 66/37 mmHg, pulse is 179/min, and respirations are 42/min. On physical exam, the patient is in moderate distress. He has low-set ears, orbital hypertelorism, and a cleft palate. The patient is centrally cyanotic. A chest CT shows thymic hypoplasia. Echocardiography demonstrates a single vessel emanating from both the right and left ventricles. This patient should be urgently evaluated for which of the following acute complications?