A 1-Day-Old Girl Undergoes Routine Congenital Heart Disease Screening in the Newborn

A 1-day-old girl undergoes routine congenital heart disease screening in the newborn nursery.  The patient was born via spontaneous vaginal delivery to a 23-year-old primigravid woman after an induction of labor at 40 weeks gestation.  The pregnancy and the delivery were uncomplicated, and the patient has stayed with her mother since delivery.  The patient is breastfeeding and has voided and stooled twice.  Pulse oximetry obtained while breathing room air is 99% oxygen saturation in the right hand and 91% in the right foot.  The patient is well appearing.  No cyanosis is seen.  Femoral and brachial pulses are 2+.  Which of the following is most likely cause of this patient's clinical presentation?

A) Hypoplasia of the aortic arch
B) Left-to-right intracardiac shunt
C) Malformation of the pulmonary veins
D) Persistence of fetal circulation
E) Right ventricular outflow tract obstruction

Correct Answer:

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