Congenitally corrected transposition of the great vessels

Lloyd E. Heller, MD; Harry G.

View content online at: http://www.appliedradiology.com/Issues/1998/07/Cases/Congenitally-corrected-transposition-of-the-great-vessels.aspx

Abstract:  IMAGING FINDINGS:

Sequential images from the helical CT examination demonstrate the trabeculated morphologic "right" ventricle on the left side communicating with the morphologic "left" ventricle via a ventricular septal defect [figure 2]. The aorta arises from the "right" ventricle and lies anterior to the pulmonary artery and to the left of midline [figure 3]. Sagittal reconstruction again shows the anterior lying aorta and demonstrates the critical subpulmonic stenosis [figure 4]. The patient subsequently underwent successful repair of his ventricular septal defect and pulmonic stenosis.

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Diagnosis
Congenitally corrected transposition of the great vessels

Discussion
Congenitally corrected transpositon refers to atrioventricular discordance, ventricular inversion, transposition and inversion of the great arter-ies.1 This is a rare condition, with an incidence of approximately 1 in 13,000 live births. It is estimated that 1% of these cases are uncomplicated (i.e., with no associated cardiac anomalies).2 These patients rarely live beyond the age of fifty; however, there is a case on record of a patient living to be 80 years old.3 Most afflicted patients die young due to associated congenital anomalies or heart block.4 Findings in these cases have been described on plain chest films, angiography and echocardiography.5 MRI and computed tomography imaging also have been used.6,7 All findings on cardiac catheterization of this patient were well visualized with helical CT. One advantage of helical CT is the rapidity of the study [30 seconds]. The short scan time allows for breath-hold imaging, thus minimizing motion artifacts. It also enables optimal timing of the bolus to obtain a continuous data set without an interval. This data set can then be used for multiplanar reconstructions. In this patient, data set images and reconstructions clearly delineated the transposed arteries and the ventricular septal defect, as well as the subpulmonic stenosis. Review of images in the cine mode can give valuable information about the direction of shunting.

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