A 1 week old baby is referred with cardiovascular collapse.
She was born at term after a difficult labour. She responded to resuscitation via bag and mask and was admitted to the NICU. Her condition improved. Four days later she developed respiratory distress initially managed on CPAP. Today she has acutely deteriorated with increasing respiratory distress, tachycardia, poor perfusion and enlarged liver 6 cm. She is intubated and ventilated.
On arrival of the team she looks clinically better.
Saturations 100% in air, HR 160, good peripheral pulses (including femoral) BP 138/95, liver is 3 cm.
Her CXR shows a slightly enlarged heart and plethoric lung fields.
What is the most striking clinical finding?
What is the most likely cause?
Comment on this CT angiogram ?