A 32weeks old male neonate was delivered vaginally with a birth weight of 1800grams due to premature labour. His right upper and lower limb oxygen saturation was 50%. In view of poor respiratory efforts, he was mechanically ventilated immediately after birth. Chest X-ray revealed bilateral diffuse interstitial reticular pattern of the lungs (Nutmeg lung) suggestive of pulmonary lymphangiectasia. Echocardiography showed intact thick interatrial septum(Figure 2A) , atresia of the mitral valve, left ventricle(Figure 2B) and aortic valve. The left atrium appeared tense with prominent appendage and the pulmonary veins were dilated(Figure 2C&D) . The pulmonary artery arose from the morphological right ventricle(RV) with adequate antegrade flows but the ascending aorta had no connection with the RV, the aortic valve was atretic and the blood flow was retrograde from Circle of Willies(Figure 2E-F) since the aortic arch was interrupted after the first branch and the patent ductus arteriosus was supplying the left common carotid artery, left subclavian artery and descending aorta[Type C interrupted aortic arch (IAA)]. There was no aortopulmonary window or visible collaterals from descending aorta. Treatment options like urgent balloon atrial septectomy for survival followed by palliative surgery like Norwood operation or primary heart transplantation were discussed. Considering the guarded long-term outcome, the parents opted for comfort care. A schematic cartoon demonstrating the anatomy and hemodynamics of the described lesion is shown in Figure 3 .