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A 2-day-old infant is dusky and irritable. He was born to a 22-year-old primigravida with sporadic prenatal care. Delivery was uncomplicated, and Apgar scores were 7 and 8 at 1 and 5 minutes, respectively. His temperature is 36.7 C (98 F), blood pressure is 70/30 mm Hg, pulse is 148/min, and respiratory rate is 68/min. Physical examination shows a cyanotic and irritable newborn with mild-to-moderate respiratory distress. Auscultation reveals a continuous, machine-like murmur appreciated between the scapulae. Serum lactate is elevated. Echocardiogram shows the aorta lying anterior, inferior, and to the right of the pulmonary artery. #IntegratedQuestion #NEXTPATTERN @medicinevideoss