Which initial management is essential for a ductus-dependent congenital heart lesion such as transposition of the great arteries?

Which initial management is essential for a ductus-dependent congenital heart lesion such as transposition of the great arteries?

• A. Administer prostaglandin E1 to maintain ductal patency
• B. Start high-flow oxygen to maximize oxygenation
• C. Immediate surgery without stabilization
• D. Observational care

Answer: (A)

In ductus-dependent lesions like transposition of the great arteries, the first priority is to keep the ductus arteriosus open so there can be mixing between the two circulations and adequate systemic perfusion. Prostaglandin E1 (alprostadil) accomplishes this by maintaining ductal patency, providing a critical bridge to definitive repair (often arterial switch) in a stable state. Without keeping the ductus open, the newborn can rapidly develop severe hypoxemia as the two parallel circuits fail to mix properly. Supplemental oxygen can help transiently, but it doesn’t address the fundamental need to keep the ductus open. Immediate surgery without stabilization ignores this lifesaving bridge, and observational care offers no active treatment.

In ductus-dependent lesions like transposition of the great arteries, the first priority is to keep the ductus arteriosus open so there can be mixing between the two circulations and adequate systemic perfusion. Prostaglandin E1 (alprostadil) accomplishes this by maintaining ductal patency, providing a critical bridge to definitive repair (often arterial switch) in a stable state. Without keeping the ductus open, the newborn can rapidly develop severe hypoxemia as the two parallel circuits fail to mix properly. Supplemental oxygen can help transiently, but it doesn’t address the fundamental need to keep the ductus open. Immediate surgery without stabilization ignores this lifesaving bridge, and observational care offers no active treatment.