A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally but now has mild shortness of breath with exertion and dizziness. What is the appropriate action?

A 5-year-old child who had a repair for transposition of the great arteries shortly after birth is growing normally but now has mild shortness of breath with exertion and dizziness. What is the appropriate action?

• A. Order an echocardiogram and chest radiograph
• B. Perform pulmonary function testing
• C. Reassure the parent that these symptoms are common
• D. Refer the child to the cardiologist immediately

Answer: (C)

New exertional shortness of breath and dizziness in a child who had repair for transposition of the great arteries raise concern for late postoperative complications that can affect heart function or the blood flow pathways. The best next step is noninvasive imaging to directly assess the heart’s current structure and function. An echocardiogram will evaluate ventricular size and performance, assess for residual or new outflow tract obstruction, valve function (including any neoaortic valve issues), and look for shunts or other hemodynamic problems. A chest radiograph complements this by showing heart size and pulmonary vasculature, helping to identify edema or other lung-related contributors. Reassurance would miss a potentially treatable problem, and while pulmonary function testing can be informative for lung-related issues, it doesn’t directly assess the heart after repair. Referring to a cardiologist is appropriate when new cardiac symptoms arise, but the initial, most informative step is imaging to guide urgent versus routine follow-up.

New exertional shortness of breath and dizziness in a child who had repair for transposition of the great arteries raise concern for late postoperative complications that can affect heart function or the blood flow pathways. The best next step is noninvasive imaging to directly assess the heart’s current structure and function. An echocardiogram will evaluate ventricular size and performance, assess for residual or new outflow tract obstruction, valve function (including any neoaortic valve issues), and look for shunts or other hemodynamic problems. A chest radiograph complements this by showing heart size and pulmonary vasculature, helping to identify edema or other lung-related contributors.

Reassurance would miss a potentially treatable problem, and while pulmonary function testing can be informative for lung-related issues, it doesn’t directly assess the heart after repair. Referring to a cardiologist is appropriate when new cardiac symptoms arise, but the initial, most informative step is imaging to guide urgent versus routine follow-up.