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Surgical Approach to Corrected Transposition of the Great Arteries Workup

  • Author: Prema Ramaswamy, MD; Chief Editor: John Kupferschmid, MD  more...
 
Updated: Jan 06, 2014
 

Imaging Studies

See the list below:

  • Chest radiography: An anteroposterior chest radiograph often reveals the characteristic features, including a straightened upper left heart border caused by the side-by-side great arteries instead of the aorta and the pulmonary arteries twisting around each other, as is observed normally. Cardiomegaly may be observed if associated conditions such as ventricular septal defect (VSD) or tricuspid regurgitation are present. See the image below.
    An anteroposterior chest radiograph revealing the An anteroposterior chest radiograph revealing the straightened left heart border formed by the aorta, which is more leftward and anterior than usual.
  • Echocardiography
    • Recent advances in the technology of Doppler echocardiography make noninvasively diagnosing this condition possible and allows for great accuracy, not only postnatally but also using fetal echocardiography. Two important, suggested clues have been the presence of a left-sided ventricle with a moderator band and an abnormal parallel orientation of the great arteries.[26]
    • Because dextrocardia is present in 25% of these patients, the position of the heart within the thorax should be initially determined. All standard views are essential to assess the atrial and ventricular morphology in detail and to look for the commonly associated malformations.
    • See the images below.
      A transthoracic echocardiogram in the apical 4-chaA transthoracic echocardiogram in the apical 4-chamber view illustrating the moderator band in the left-sided ventricle and the apically displaced left atrioventricular valve suggesting that it is the morphologic right ventricle.
      A transthoracic echocardiogram in the parasternal A transthoracic echocardiogram in the parasternal short axis view demonstrating the anterior and leftward aorta. The left coronary artery can be observed at the 10-o'clock position.
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Other Tests

See the list below:

  • ECG may provide the most significant clue of this condition. The presence of Q waves over the right precordium (because of reverse septal depolarization) with absent Q waves over the lateral precordium in the absence of other criteria for right ventricular hypertrophy should suggest this defect.
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Diagnostic Procedures

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  • Angiocardiography is no longer required for the diagnosis because echocardiographic findings are diagnostic. Real danger of causing complete heart block exists during this procedure because the atrioventricular (AV) bundle is located on the left ventricular side of the septum, and because the left ventricle is connected to the right atrium, it is in the direct path of a catheter in a right heart catheterization.[14]
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Contributor Information and Disclosures
Author

Prema Ramaswamy, MD Associate Professor of Clinical Pediatrics, New York University; Adjunct Associate Clinical Professor of Pediatrics, St George’s University School of Medicine; Co-Director of Pediatric Cardiology, Maimonides Infants and Children's Hospital of Brooklyn, Lutheran Medical Center, and Coney Island Hospital

Prema Ramaswamy, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Cardiology

Disclosure: Nothing to disclose.

Coauthor(s)

Khanh Nguyen, MD Assistant Professor, Department of Cardiothoracic Surgery, Mount Sinai School of Medicine; Chief of Pediatric Cardiac Surgery, Department of Surgery, Mount Sinai Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

John Myers, MD Director, Pediatric and Congenital Cardiovascular Surgery, Departments of Surgery and Pediatrics, Professor, Penn State Children's Hospital, Milton S Hershey Medical Center

John Myers, MD is a member of the following medical societies: American Association for Thoracic Surgery, American College of Cardiology, American College of Surgeons, American Heart Association, American Medical Association, Congenital Heart Surgeons Society, Pennsylvania Medical Society, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

John Kupferschmid, MD Director of Congenital Heart Surgery, Department of Surgery, Methodist Children's Hospital at San Antonio

John Kupferschmid, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, Society of Thoracic Surgeons, Society of Thoracic Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Daniel S Schwartz, MD, FACS Medical Director of Thoracic Oncology, St Catherine of Siena Medical Center, Catholic Health Services

Daniel S Schwartz, MD, FACS is a member of the following medical societies: Society of Thoracic Surgeons, Western Thoracic Surgical Association, American College of Chest Physicians, American College of Surgeons

Disclosure: Nothing to disclose.

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A 12-lead ECG demonstrating the characteristic features of corrected transposition Q waves in III, in aVF, and in the right precordial leads.
An anteroposterior chest radiograph revealing the straightened left heart border formed by the aorta, which is more leftward and anterior than usual.
A transthoracic echocardiogram in the apical 4-chamber view illustrating the moderator band in the left-sided ventricle and the apically displaced left atrioventricular valve suggesting that it is the morphologic right ventricle.
A transthoracic echocardiogram in the parasternal short axis view demonstrating the anterior and leftward aorta. The left coronary artery can be observed at the 10-o'clock position.
 
 
 
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