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Right ventricular (RV) function is important for clinical status and outcomes in children and adults with congenital heart disease (CHD). In the normal RV, longitudinal systolic function is the major contributor to global RV systolic function. A variety of factors contribute to RV failure including increased pressure- or volume-loading, electromechanical dyssynchrony, increased myocardial fibrosis, abnormal coronary perfusion, restricted filling capacity and adverse interactions between left ventricle (LV) and RV. We discuss the different imaging techniques both at rest and during exercise to define and detect RV failure. We identify the most important biomarkers for risk stratification in RV dysfunction, including abnormal NYHA class, decreased exercise capacity, low blood pressure, and increased levels of NTproBNP, troponin T, galectin-3 and growth differentiation factor 15. In adults with CHD (ACHD), fragmented QRS is independently associated with heart failure (HF) symptoms and impaired ventricular function. Furthermore, we discuss the different HF therapies in CHD but given the broad clinical spectrum of CHD, it is important to treat RV failure in a disease-specific manner and based on the specific alterations in hemodynamics. Here, we discuss how to detect and treat RV dysfunction in CHD in order to prevent or postpone RV failure. ispartof: CARDIOVASCULAR DIAGNOSIS AND THERAPY vol:10 issue:5 pages:1625-1645 ispartof: location:China status: published

A 51-year-old man, who had a history of open heart surgery for corrected transposition of great arteries, presented with palpitation due to atrial tachycardia. A propagation map using three-dimensional electroanatomical mapping (CARTO3) showed atrial flutter and underwent linear ablation successfully. This case highlights the difficulty of diagnosis before mapping following a complicated cardiac operation and the usefulness of three-dimensional mapping.

Congenitally corrected transposition of great arteries (CCTGA) is associated with increased risk for complete heart block. The morphologic right ventricle is at increased risk for pacing-induced cardiomyopathy and heart failure. In this report, we present a case of successful His bundle pacing (HBP) guided by 3-dimensional (3D) mapping in a patient with CGTGA.

Introduction: Physiologically corrected transposition of the great arteries [(S,L,L) TGA] is a rare congenital heart disease characterized by atrioventricular and ventriculoarterial discordance. Case Presentation: A 28-year-old man with (S,L,L) TGA, pulmonary valve (PV) stenosis, ventricular septal defect (VSD), and history of Kawasaki disease who presented for a gradual decline in exercise tolerance. Oxygen saturation was 96% at rest and dropped to 86% with ambulation. Hemoglobin was 17.7 g/dl, EKG showed no bradyarrhythmias. On stress test, peak heart rate was 159 beats/minute, and peak VO 2 22.6 ml/kg/min (83%, and 57% of predicted value respectively). Spirometry was normal. Transthoracic echocardiogram revealed biventricular hypertrophy with normal systolic function, a bicuspid PV with severe stenosis (peak and mean gradient of 155 and 90 mmHg respectively), large inlet VSD with bidirectional flow and mild systemic TV regurgitation. Coronary CTA showed no coronary artery aneurysms. Cardiac catheterization suggested hypoxia due to pulmonary-to-systemic shunting across the VSD with Q p /Q s = 0.86 (Figure). Consideration should be given to performing a high-risk surgical repair versus medical management. Conclusions: Natural history, symptoms, and timing of intervention are determined by the associated cardiac anomalies and the progressive dysfunction of the systemic right ventricle (SRV). Anatomic repair to restore the left ventricle as a systemic pump is a very high-risk procedure in adults. Functional repair maintains SRV, repair the VSD, and PV stenosis has a poor late outcome. Medical management ensures iron stores are repleted, provide empirical use of pharmacological heart failure therapy, and referral to heart transplantation when SRV systolic dysfunction ensues. Clinicians need to know the potential complications in both unoperated patients and following various surgical repairs to recommend appropriate treatment options.

Purpose To analyze anatomic features and associated malformations in 37 prenatally detected cases of congenitally corrected transposition of the great arteries (ccTGA) and to evaluate the prenatal course, neonatal outcome and mid-term follow-up. Methods Retrospective analysis of prenatal ultrasound of 37 patients with ccTGA in two tertiary centers between 1999 and 2019. All fetuses received fetal echocardiography and a detailed anomaly scan. Postnatal outcome and follow-up data were retrieved from pediatric reports. Results Isolated ccTGA without associated cardiac anomalies was found in 13.5% (5/37), in all other fetuses additional defects such as VSD (73.0%), pulmonary obstruction (35.1%), tricuspid valve anomalies (18.9%), aortic arch anomalies (13.5%), ventricular hypoplasia (5.4%) or atrioventricular block (5.4%) were present. The rate of extracardiac malformations or chromosomal aberrations was low. There were 91.9% (34/37) live births and postnatal survival rates reached 91.2% in a mean follow-up time of 4.98 years. The prenatal diagnosis of ccTGA was confirmed postnatally in all but one documented live birth and the prenatal counselling regarding the expected treatment after birth (uni- versus biventricular repair) was reassured in the majority of cases. The postnatal intervention rate was high, 64.7% (22/34) received surgery, the intervention-free survival was 36.7%, 35.0% and 25.0% at 1 month, 1 year and 10 years, respectively. Conclusions ccTGA is a rare heart defect often associated with additional heterogeneous cardiac anomalies that can be diagnosed prenatally. The presented study demonstrates a favorable outcome in most cases but the majority of patients require surgical treatment early in life.

The discordance between increased physiological demand during pregnancy and congenital cardiac pathology of a parturient is a perilous threat to the maternal-fetal well-being. Early involvement of a multidisciplinary team is essential in improving peripartum morbidity and mortality. Designing the most appropriate anesthetic care will require a concerted effort, with inputs from the obstetricians, obstetric and cardiac anesthesiologists, cardiologists, neonatologists, and cardiothoracic surgeons. We report the multidisciplinary peripartum care and anesthetic management for cesarean section (CS) of a 28-year-old primigravida who has partially corrected transposition of the great arteries, atrial and ventricular septal defect, dextrocardia, right ventricle hypoplasia, and tricuspid atresia.

Patient YB, 50 years old, female, with hypothyroidism, severe left ventricular dysfunction, uncompressed left ventricle and poorly tolerated ventricular tachycardia, submitted to implantation of a dual chamber implantable cardioverter-defibrillator (ICD) in February 2012 (generator Secura DR Medtronic, 4076 Medtronic atrial electrode, and Sprint Quattro 6947 Medtronic ventricular electrode). Returns asymptomatic nine months after the implant for routine evaluation.

Congenitally corrected transposition of the great arteries is a rare heart defect that can be associated with systemic ventricular dysfunction and conduction disturbances. The use of cardiac resynchronization therapy in patients with congenital heart disease is not fully established, and achievement of successful pregnancies after implantation of transvenous, biventricular system has never been described, and which resulted in a significant clinical improvement. We describe a 33-year-old female with congenitally corrected transposition of the great arteries, who achieved six pregnancies and successful vaginal deliveries. The two last pregnancies were achieved after cardiac resynchronization therapy for systemic ventricular dysfunction and complete heart block. A congenital cardiac disease has been identified in only one offspring.

Situs inversus with levocardia and congenitally corrected transposition of the great arteries represents a relatively very rare congenital condition and most patients are diagnosed in infancy or early age. This case report describes a 35-year old man with congenitally corrected transposition of the great arteries which presented with a five month history of exertional dyspnea. A diagnosis was confirmed by transesophageal echocardiogram, showing situs inversus, levocardia, atrioventricular and ventriculoarterial discordance. He underwent physiologic repair, and was discharged thirty five days after the operation, in a good general condition. Although management of the corrected transposition of the great arteries patients remains controversial, the recommendation is that physiologic repair may be the procedure of choice for some patients, particularly complicated cases.

This chapter presents data drawn from a number of interesting and informative cases focusing on patients with unusual congenital heart defects and/or intracardiac shunts.

Corrected transposition of the great arteries is a rare pathology with an incidence of 1% among the congenital heart diseases.It is thought to have multifactorial inheritance. It is mostly seen in men. If there is no concomitant pathology, the blood flow isphysiological and does not show symptoms until advanced ages. Life expectancy is close to normal in those with isolated pathology.Risk factors determining mortality include progressive right ventricular dysfunction, AV block, and severe tricuspid insufficiency. Inthis case, we present a CCTGA patient with dyspnea symptoms without any additional pathology.

The hallmark of corrected transposition is discordance at atrio-ventricular and ventriculo-arterial level and that is defined as “double discordance”. This can occur as an isolated anomaly but more commonly has associated defects; most common being ventricular septal defect followed by tricuspid valve abnormalities. Other associated defects are pulmonary stenosis, systemic and pulmonary venous anomalies, univentricular physiology, ventricular dysfunction (morphological right ventricle facing systemic circulation) and association of conduction abnormalities. Echocardiography plays a pivotal role in defining the anatomy and planning the management. In this article we are discussing about role of echocardiography in evaluation of corrected transposition, diagnosing the lesion, role in immediate post-operative period and on follow up.

We describe the case of a 52-day-old child who was diagnosed with a rare combination of corrected transposition of great vessels – hypoplastic right ventricle with supracardiac total anomalous pulmonary venous connection.

The case of prenatal ultrasound diagnosis of combination corrected transposition of the great arteries (cTGA) with dextrocardia at 21 weeks of gestation is presented. The high-level ventricular septal defect and stenosis of pulmonary artery were associated cardiac pathologies. Another anomalies of the fetus were not detected. The fetus karyotype was normal, defined by classical cytogenetic analysis. The prenatal consultation assessed the prognosis for life and health as unfavorable. According to patient’s decision the pregnancy was terminated. Literature review of antenatal diagnostics of cTGA and combined cTGA with dextrocardia and the matters of short- and long-term prognosis for the fetus were presented in the paper. The issues of the difficulty of detecting cTGA in a fetus and prenatal counseling is discussed, especially in the presence of an abnormality of the intrathoracic location of the heart.

PURPOSE OF REVIEW: The right ventricle (RV) is uniquely at risk in many patients with repaired or palliated congenital heart disease (CHD) such as tetralogy of Fallot, corrected transposition, single right ventricle, and in those with pulmonary hypertension. These patients live with abnormal cardiac loading conditions throughout their life, predisposing them to right heart failure. RECENT FINDINGS: Standard heart failure therapies, developed to treat left ventricular failure, have failed to improve function or survival in patients with RV failure, suggesting a divergence in the molecular mechanisms of right versus left ventricular failure. As surgical techniques for repair of the most complex forms of RV-affecting CHDs continue to improve, more children with CHD will survive into adulthood. Long-term survival and quality of life will ultimately depend on our ability to preserve RV function. SUMMARY: The purpose of this review is to highlight the differences between the right and left ventricular responses to stress, our current knowledge of how the RV adapts to the unique hemodynamic stressors experienced by patients with CHD, and the need to better understand the molecular mechanisms of RV failure, providing new targets for the development of RV-specific heart failure therapeutics.

A 35 year old male, known case of corrected transposition of great arteries presented with exertional dyspnea and recurrent pre-syncope. 12 lead electrocardiogram revealed a regular rhythm at 75 beats per minute, P waves occurring on the upstroke of T waves and apparent 1:1 P-QRS relationship. The possibilities to be considered – complete AV block with junctional escape, junctional rhythm with 1:1 retrograde conduction, junctional rhythm with isorhythmic AV dissociation and prolonged PR interval have been discussed.

Corrected transposition is a relatively uncommon congenital heart defect characterized by discordance at both the atrioventricular and ventriculoarterial levels. A rare subset of patients with corrected transposition also have criss-cross atrial morphology. We report the surgical treatment of 2 patients with corrected transposition in association with criss-cross atrial morphology, emphasizing the novel atrial baffle required for this operation.

A 3-year-old boy underwent evaluation for dextrocardia. Echocardiograms showed features of corrected transposition physiology, a perimembranous ventricular septal defect (VSD) (Fig. 1), and aneurysmal tissue beneath the pulmonary valve that caused severe subpulmonary stenosis (Figs. 2–4). Eighteen months after VSD closure and resection of the aneurysmal tissue, the patient was asymptomatic with only mild residual pulmonary outflow tract obstruction. Fig. 1. Two-dimensional echocardiograms A) in apical 4-chamber view from the right chest and B) in color-flow Doppler mode show a moderate-to-large ventricular septal defect (VSD). Fig. 2. Echocardiograms (subcostal 4-chamber views). A) In the morphologic left ventricle (MLV), aneurysmal tissue (arrow) protrudes into the pulmonary outflow tract. B) Color-flow Doppler mode reveals turbulent flow (arrow) in the pulmonary outflow tract. Fig. 3. A) Continuous-wave Doppler echocardiographic recording across the pulmonary outflow tract shows a peak velocity >5 m/s, suggesting severe obstruction. B) Angiogram (60° left anterior oblique view) from the morphologic left ventricle (MLV) ... Fig. 4. Cineangiographic image from the A) left lateral view reveals the morphologic left ventricle (MLV) and the pulmonary outflow tract obstruction from aneurysmal tissue (arrows). B) The 60° left anterior oblique view reveals a severely narrowed right ...

A concomitant double-switch procedure and unifocalization were performed in a child with congenital corrected transposition of the great arteries, ventricular septal defect, pulmonary atresia, absence of central pulmonary arteries and major aortopulmonary collateral arteries. Predischarge echocardiography showed no residual shunts with laminar flow in baffles and outflow tracts. Follow-up computed tomographic angiography revealed good neo-main pulmonary artery confluence with satisfactory pulmonary blood flow.

Complex congenital heart diseases involving abnormalities of the atrial situs and cardiac malpositions like dextrocardia can pose a considerable challenge to transvenous permanent pacemaker implantation (PPI). Literature describing transvenous PPI techniques in patients with complex cardiac anomalies is scarce. In this report, we describe a novel angiography-guided technique for the implantation of a dual chamber transvenous pacemaker in a patient with complete heart block with situs solitus, dextrocardia, and congenitally corrected transposition of the great arteries.

The number of adult patients with a systemic right ventricle (RV) is steadily increasing. Survival is relatively good in these patients, but deterioration of the systemic RV seems inevitable. Although therapeutic options for patients with LV failure are well established, their role in patients with systemic RV failure is often undefined. To appreciate the potency of LV failure therapy in patients with a systemic RV, insight into pathophysiology of systemic RV failure and into recent developments in therapeutic research are indispensible. This review provides these insights, and will facilitate and ameliorate therapeutic decision making in patients with a systemic RV.

A full-term male newborn weighing 2.7 kg was evaluated because of suspected cyanotic congenital heart disease on the day of birth. The echocardiographic study showed corrected transposition of the great arteries, severe tricuspid stenosis, right ventricular (RV) hypoplasia, aortic atresia, intact ventricular septum, and ventriculo-coronary arterial connections (VCACs) ( Panel A , yellow arrow). RV …

The neuro-cutaneous syndrome tuberous sclerosis is commonly associated with rhabdomyomas in various organs including the heart. We are reporting a rare case of a 7-month old male child with congenitally corrected transposition of the great arteries associated with tuberous sclerosis and cardiac rhabdomyomas. To our knowledge, this rare association has not been reported so far.

The management of congenitally corrected transposition of the great arteries and associated lesions is frequently challenging. Restrictive ventricular septal defect and mild pulmonary stenosis are contraindications to the double switch procedure, including the atrial-Rastelli switch procedure, due to the production of postoperative left ventricular outflow tract obstruction. We describe a case of aortic translocation using the hemi-Mustard procedure after left ventricular training in order to prevent postoperative left ventricular outflow obstruction.

We report a case with dextrocardia, corrected transposition of the great arteries. He also had an atrial septum defect (ASD) with patch repair. Activation map showed a centrifugal activation from a focal origin on the systemic lower left atrial ASD patch. Ablation of the origin can terminate the atrial tachycardia. (PACE 2012; 35:e306–e308)

The corrected transposition of the great arteries is a rare congenital cardiac anomaly characterised by atrio-ventricular and ventriculo-arterial discordance and is related to the largest incidence of cardiological complications. We report on a 40-year-old woman with congenitally corrected transposition of the great arteries, situs inversus, atrial septal defect, pulmonary stenosis, right arcus aorta and coronary artery anomalies.

A 12 year-old girl with corrected transposition (L-transposition of the great arteries with ventricular inversion) and congenital complete atrioventricular block underwent epicardial pacemaker implantation with a single ventricular lead at 1 week of life. Subsequently, she presented for routine follow-up care in the electrophysiology clinic with no symptomatic concerns. She denied chest pain. Her physical examination was unremarkable, with the pacemaker generator palpable in the left subcostal region. ECG at that time demonstrated ventricular pacing with 100% capture and no evidence of atrioventricular conduction. Her chest x-ray revealed that the pacemaker lead completely encircled the cardiac silhouette and prompted concern for cardiac strangulation (Figure 1). A subsequent computed tomography scan showed a likely restrictive effect on both ventricles caused by the pacemaker lead encircling the heart with concern …

Corrected transposition of the great arteries (cTGA) is a rare congenital heart disease. c-TGA occurs in 0.5% of patients born with congenital heart disease. Other congenital heart defects commonly accompany this anomaly. Prognosis depends on systemic ventricular function, anomalies accompanying anomalies. The patient was conduction, Büyük damarların düzeltilmiş transpozisyonu (c-TGA) nadir görülen konjenital bir kalp hastalığıdır. Konjenital kalp hastalığı ile doğanların %0,5’inde görülür. Diğer konjenital kalp defektleri bu anomaliye genelde eşlik ederler. Prognoz; sistemik ventrikül disfonksiyonuna, eşlik eden kalp defektlerine ve ileti sistemi anomalilerine bağlıdır. Hasta bize kardiak üfürüm nedeniyle yönlendirildi. Muayenesinde bradikardi ve triküspit odakta 2/6 pansistolik üfürüm duyulmaktaydı. Vakamız 17 günlükken tanı almış fakat asemptomatik olması dolayısıyla ailesi tarafından bu konu önemsenmemişti. Elektrokardiyografide; tam atriyovetriküler blok, kalp hızı 66/dk, V1’de Q dalgası varken V5-6’da Q dalgası yok olarak saptandı. Transtorasik ekokardiyografik incelemede ise izole c-TGA ve birinci derece triküspit kapak yetmezliği görüldü. Bu vakayı sunmak istememizin sebebi; intrakardiak anomaliler olmaksızın büyük damarların düzeltilmiş transpozisyonunun oldukça ender görülen bir durum olmasıdır. Ayrıca bu vaka 11 yaşına gelmesine rağmen hiçbir semptomunun açısından da ilginçtir.Anahtar kelimeler: Atriyoventriküler blok, büyük damarların düzeltilmiş transpozisyonu, triküspit yetmezliği

Aims Dextrocardia is a rare congenital anomaly. Pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy and associated anomalies. The literature regarding implantation of pacemaker in dextrocardia is scarce. Methods and results The study involved retrospective analysis of records of patients with dextrocardia who had undergone pacemaker implantation between January 2006 and July 2013 from a single centre. Six patients with dextrocardia (five males and one female) underwent permanent pacemaker implantation (PPI) between January 2006 and July 2013. Of them, three had situs solitus dextrocardia and three situs inversus dextrocardia. All three patients with situs solitus dextrocardia had associated corrected transposition of great arteries. The indication for pacemaker implantation was symptomatic complete atrioventricular (AV) block in four, high-grade AV block in one, and sinus node dysfunction in one patient. A favourable outcome was noted during a mean follow-up of 3.9 years (4 months to 7 years) with one patient needing a pulse generator replacement. Conclusion Permanent pacemaker implantation in dextrocardia can be challenging because of the distorted anatomy. Use of a technique employing angiography to delineate chamber anatomy and relationship can assist the operator during such difficult PPIs. The medium- and long-term survival after a successful pacemaker implantation in dextrocardia is favourable.

Kartegener syndrome is characterized with sinusitis, bronchiectasia and dextrocardia. There may be rhythm and conduction abnormalities. Due to the cilial dysfunction lung abscesses and disorders of sperm motilities may also be seen. Additional cardiac abnormalities is very rare. We reported a case with Kartagener's syndrome with a corrected transposition.

We present a case of a 69 year-old woman complaining of palpitations and worsening heart failure, after the 2nd cycle of fludarabine due to Hodgkin's lymphoma. Echocardiography revealed abnormalities typical for corrected transposition of the great arteries (CTGA), which were confirmed in multislice computed tomography (MSCT), as well as subvalvular pulmonary stenosis. There is the case of one of the oldest patients with CTGA and subvalvular pulmonary stenosis. MSCT seems to be a useful and complementary method in diagnosis such diseases.

A transposição corrigida das grandes artérias, cardiopatia congênita rara, está relacionada a maior incidência de complicações cardiológicas. Reportamos um caso no qual a apresentação clínica da doença ocorreu apenas na quinta década de vida, com insuficiência tricúspide, ocasião em que a paciente foi submetida a troca valvar. The corrected transposition of the great arteries, rare congenital cardiopathy, is related to the largest incidence of cardiological complications. We report a case in which the clinical presentation of the disease occurred in the fifth decade of life, with tricuspid insufficiency, occasion that the patient was submitted to valvar replacement.

We report the first known case of AV nodal reentrant tachycardia (AVNRT) associated with a corrected transposition of the great arteries to be treated successfully by ablation of the slow pathway. Triple AV nodal pathways were observed in the anterograde direction and two types of AVNRT were induced. Input of the fast pathway to the AV node was located at the anterior portion of the left-sided AV annulus, while the input of the intermediate and slow pathways was located at the anteroseptal portion of the right-sided AV annulus. Radiofrequency energy ablation at the right anteroseptal site eliminated the intermediate and slow pathways.

Background Congenital heart diseases (CHD) are responsible for substantial morbidity and mortality in neonates. The preliminary diagnosis often is made by noncardiologists. For this reason, there is a huge demand of training in echocardiography of CHD. This is difficult to achieve due to limited resources of specialized centers. Objective The goal of this study was to investigate the training effect of the echocardiography simulator EchoCom on trainee's ability to diagnose CHD. Design/Methods We enrolled 10 residents for simulator-based training in echocardiography of CHD. All participants were instructed on the simulator's basic handling and had one hour to scan the first 9 datasets information (ventricular septal defect, atrial septal defect, atrioventricular septal defect, Tetralogy of Fallot, transposition of great arteries, congenital corrected transposition of great arteries, common arterial trunk, hypoplastic left heart syndrome, normal anatomy) and establish a diagnosis. No help was given except for support regarding simulator related issues. Afterward, 2 rounds of structured simulator based echocardiography training focused on echocardiographic anatomy, spatial orientation, standard views, and echocardiographic anatomy of different CHD followed. All participants completed a standardized questionnaire containing 10 multiple-choice (MC) questions focusing on basic theoretical knowledge in echocardiographic anatomy and common CHD. Results Almost all of the residents invited from the affiliated children's hospital had little (20%) or no experience (80%) in echocardiography of CHD. Their Pretest and Posttest scores showed significant improvement for both, MC test and performance test, respectively. Conclusions Our study showed that simulator-based training in echocardiography in CHD could be very effective and may assist with training outside the scope of CHD.

OBJECTIVES--A combined atrial and arterial switch procedure was performed in selected patients with congenitally corrected transposition to establish the morphological left ventricle as the systemic ventricle. Immediate and early follow up results are presented. BACKGROUND--Progressive right ventricular dysfunction and tricuspid regurgitation are common in patients with congenitally corrected transposition who undergo repair of associated lesions. A surgical procedure which re-establishes the left ventricle as the systemic ventricle should improve functional results. METHODS--Four symptomatic children aged from 9 months to 3 years 1 month (mean 2 years 3 months) with congenitally corrected transposition and ventricular septal defect underwent both an atrial and arterial switch procedure and were followed up for a mean of 12 months (range 6-21 months). RESULTS--There were no early or late deaths. Conduction abnormalities worsened in two patients. Hospital stay ranged from 8 to 17 days (mean 13 days). The cardiothoracic ratio decreased from a mean (range) of 0.65 (0.6 to 0.71) to 0.58 (0.52 to 0.6). Currently, three patients are in functional class I and one child is in functional class II. CONCLUSIONS--The combination of an atrial and an arterial switch procedure in symptomatic children with congenitally corrected transposition establishes the left ventricle as the systemic ventricle. The initial experience is encouraging with excellent immediate and early follow up results.

A 42-year-old woman with corrected transposition of the great arteries in situs inversus totalis , after Rastelli operation with prophylactic epicardial ventricular lead implantation ( Panel …

Today, an increasing incidence of severe complications of cardiac malformations in adult patients must be expected since the life expectancy of such individuals is prolonged due to improved management. A 32-year-old woman with corrected transposition of the great arteries (CTGA) was admitted to the intensive care unit because of cardiac decompensation. Information provided by multiplane two-dimensional transesophageal echocardiography was not sufficient for an unequivocal explanation of the cardiac decompensation. In CTGA uncommon complications may cause pulmonary edema. Using dynamic three-dimensional echocardiography to reveal function, volume parameters and the morphology of both ventricles and to exclude additional complications may be considered an adequate diagnostic tool for responding to this challenge.

We reported a 26-year-old female with congenitally corrected transposition of the great arteries, dextrocardia, cardiac situs inversus, and episodes of supraventricular tachycardia (A). A three-dimensional (3D) reconstruction image was made by computed …

Congenitally corrected transposition is a rare condition, characterized by atrio-ventricular and ventricular–arterial discordance. The clinical presentation and indication for surgery generally depends on the associated cardiac lesions such as ventricular septal defect, obstruction of the outflow tract from the morphologically left ventricle, abnormalities of the morphologically tricuspid valve, and problems with the conduction system.

Sternal infection has become a rare but challenging problem with significant mortality and morbidity rates since the introduction of sternotomy. Reported rates of mediastinal and sternal infection range from 0.4% to 5%. The ideal reconstruction after sternal debridement is still controversial. Different methods, such as debridement and open packing with continuous antibiotic irrigation, or sternectomy with omental or muscle transposition have been proposed. In this study, we present the cardiac reoperation of a 52 year old man with corrected transposition of great arteries (c-TGA) who had undergone a previous omentoplasty for postoperative mediastinitis.

This report presents a patient with complex congenitally corrected transposition of the great arteries (ccTGA) and concomitant ventricular septal defect (VSD), who developed symptomatic heart failure further aggravated after dual-chamber pacemaker implantation. The initial disqualification from surgery based on high vascular pulmonary resistance was verified in repeated catheterization. The oxygen test was positive, therefore the patient underwent surgical correction. Despite successful repair with the use of two prosthetic valves (mechanical and biological) and an intraventricular patch, the symptoms of heart failure persisted. In view of the prolonged QRS complex on the ECG and the signs of significant intraventricular mechanical dyssynchrony measured by Tissue Doppler Imaging (TDI), the patient was referred for cardiac resynchronization therapy (CRT). A biventricular pacemaker allowed a larger synchronicity of systemic RV systolic function and the improvement of the patient's general condition. The case described indicates that optimal care in patients with ccTGA can require implementation of both surgical and electrophysiological methods of treatment.