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1. 1. The authors have reviewed the normal development of the bulboventricular loop, the ventricles, and the great vessels in the human embryo. 2. 2. Corrected transposition of the great vessels in any of its varieties is a complex malformation in which two embryonic elements are involved: the bulboventricular loop and the truncoconal septum. 3. 3. An embryologic explanation for the different varieties of corrected transposition of the great vessels is proposed. The anatomic features of all these varieties (in normally situated heart, in mirror-image dextrocardia, in one type of levocardia, and in the case of dextrorotation) are also given. 4. 4. A new theory based on recent embryologic findings is offered to explain the development of corrected transpositions of the great vessels.

The distribution of blood-flow to the right and left lung appears to be governed, at least in part, by the anatomical disposition of the pulmonary outflow tract. In some cases of transposition of the great arteries, particularly when there is corrected transposition in association with single ventricle, the pulmonary outflow tract appears to be directed towards the right hilum. This leads to prominent right hilar vascularity in the radiograph, to earlier filling and clearing of the right lung, and to a greater flow through that lung.

The various clinical, electrocardiographic, radiologic, angiocardiographic, and cardiac catheterization features in a case of ◀functionally totally corrected transposition” without any associated defects are presented. To our knowledge, this is the first case in which detailed studies are available and in which a diagnosis has been feasible ante mortem.

The clinical course and laboratory findings in the case of a 45-year-old woman with corrected transposition of the great vessels and no associated defects are reported. Spontaneous systemic ventricular failure occurred at the age of 45 without obvious cause. The possibility is raised that this represents failure of the anatomic right ventricle to sustain systemic pressures for a normal lifetime. This patient is discussed in relation to present surgical techniques for correcting transposition of the great vessels which leave the right ventricle as the systemic pump.

A case of left Ebstein's anomaly in association with corrected transposition of the great vessels, subpulmonary stenosis and a ventricular septal defect is presented. Surgical treatment of the subpulmonary stenosis and ventricular septal defect was carried out on cardiopulmonary bypass. The anatomic handicaps peculiar to corrected transposition which confront the surgeon in correcting these associated anomalies are discussed. The left Ebstein's anomaly discovered at autopsy was unsuspected during life and could not be recognized by external examination of the heart in this case. At postmortem examination the nonatrialized portion of the left ventricle appeared too small to maintain the systemic circulation. It is believed that this factor alone led to the patient's death once the ventricular septal defect had been closed. Attention is again drawn to the common occurrence of abnormalities of the left atrioventricular valve in association with corrected transposition, left Ebstein's malformation being one of the rarer forms. It is recommended that digital exploration of the left atrium be carried out in all cases of corrected transposition selected for open cardiotomy procedures.

The case of a 73-year-old white man with corrected transposition of the great vessels and associated mitral and mild aortic regurgitation is reported. The patient's survival was the longest of any patient with this defect reported to date. Although the condition is theoretically compatible with a normal life span, few patients with this lesion survive past 40 years of age because of associated congenital defects or the subsequent development of A-V valvular insufficiency or heart block, or both.

A case of corrected transposition of the great vessels with bulbar inversion alone (type B1) is described in detail. This case further substantiates the classification of transposition variants as presented by Harris and Farber and by Cardell.

The clinical, angiocardiographic, vectorcardiographic and phonocardiographic findings in a fifty-four year old man with uncomplicated corrected transposition of the great vessels are presented. A soft, grade 26 precordial systolic murmur was present, and the second heart sound at the base appeared single on auscultation but was normally and narrowly split on phonocardiogram. The P-R interval was prolonged and paroxysmal nodal tachycardia frequently occurred. The patient never manifested any evidence of heart failure and the inverted ventricles functioned well with their reversed pressure and volume loads. Sixteen well documented cases of uncomplicated corrected transposition have been reported in the American literature, and the available clinical data on seven of these cases are reviewed. The present patient is the only one in the older age group with complete antemortem documentation of all cardiovascular parameters.

The clinical course and autopsy findings are described in a patient with corrected transposition of the great vessels associated with bicuspid pulmonary and aortic valves and severe aortic insufficiency. The physiologic abnormalities resulting from these anomalies and the surgical and embryologic implications of this constellation are discussed.

A 38-year-old woman is reported who had corrected transposition of the great vessels and associated left-sided atrioventricular (A-V) valve insufficiency without intracardiac septal defects. Successful resection of the tricuspid valve and implantation of a fresh aortic homograft on a support ring were carried out.

This is a brief review of the clinical and pathologic features of corrected transposition of the great vessels of the heart. In this condition, the aorta and pulmonary artery are transposed, with the aorta lying anterior to the pulmonary artery; however, the aorta arises from the left-sided ventricle and carries oxygenated blood, while the pulmonary artery arises from the right-sided ventricle and carries venous blood. There is usually, also, localized inversion of the ventricles and the coronary arteries. Clinical manifestations result from the frequently associated cardiac anomalies, especially interventricular septal defect. Three case reports of corrected transposition are presented. These were studied both clinically and at autopsy.

This report describes a patient with corrected transposition of the great vessels and with an aneurysm of the membranous portion of the ventricular septum, which was surgically repaired. The aneurysm caused obstruction of the outflow tract of the venous ventricle, a hemodynamic complication that is essentially inevitable when an aneurysm of significant size develops in the presence of ventricular inversion. Subvalvular pulmonic stenosis was also present.

Dados clinicos Paciente evolui sem sintomas, nos afazeres habituais como domestica e costureira, quando foi identificado em avaliacao de rotina bloqueio atrioventricular total com frequencia cardiaca de 66 bpm. Nesta ocasiao foi feito diagnostico de transposicao corrigida das grandes arterias (TCGA) por ecocardiograma, com insuficiencia discreta da valva atrioventricular esquerda. Por insuficiente cronotropismo e doenca binodal, foi colocado, aos 59 anos de idade, marcapasso atrioventricular a direita. Permanece assintomatica em uso de medicacao anti-hipertensiva, anlodipina, enalapril e hidroclorotiazida. Nega qualquer [...]

Clinical and pathological data of a full-term male newborn with Ebstein's malformation of the mitral valve are reported. Moderate cyanosis and progressive heart failure were present from birth and he died on the fourth day after birth, with clinical evidence of severe aortic coartaction. Necropsy revealed a severely dysplastic mitral valve, with anatomical features of Ebstein's anomaly, in the absence of corrected transposition but associated with aortic coartaction.

Successful surgical repair of a 4-year-old boy with situs inversus {I,D,D} and corrected transposition of the great vessels (TGV) as well as hemodynamically significant ventricular septal defect (VSD), systemic atrioventricular (tricuspid) valve regurgitation, and atrial septal defect is described. Unique technical aspects of VSD and tricuspid valve repair in association with corrected TGV and situs solitus or inversus are discussed and clarified.

OP-084 Congenital corrected transposition of the great arteries is a group of clinically heterogeneous diseases because of numerous accompanying anomalies. In this study, we aimed to conduct retrospective analysis of the data of the patients who were diagnosed and followed up at our center. Among

To the Editor.— An 18-year-old man with cyanotic congenital heart disease (corrected transposition with tight pulmonic stenosis and ventricular septal defect and a Blalock-Taussig shunt) began to complain of increasing cyanosis and dyspnea after riding his bike the one mile to and from his home and school. His symptoms suggested that he was outgrowing his shunt and preparations were begun for studies at the local medical center. Just before his admission, however, his mother canceled it, explaining that the au pair staying at her house had asked why Jason insisted on riding a bike with two flat tires. The addition of 70 psi of air to his bicycle tires ended his complaints.

Congenital transposition of the efferent vessels of the heart is defined by Abbott1as "an alteration in the position of the two great vessels relative to the ventricles of the heart or to each other at their origin, so that they either spring from reversed ventricles, the aorta from the right and the pulmonary artery from the left chamber (complete transposition) or from the ventricles to which they normally belong, but in a reversed relationship (corrected transposition)." The cases of congenital heart disease with marked cyanosis referred to by older writers as morbus caeruleus are for the most part due to this condition, as cyanosis, as will be considered later in detail, is here of the most extreme and persistent type. This anomaly must be clearly distinguished from the type of transposition of the entire organ together with the vessels, so that it is in reality either a complete